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CRYSTAL CLARITY MICRODERMABRASION CREME
  • CRYSTAL CLARITY MICRODERMABRASION CREME
CRYSTAL CLARITY MICRODERMABRASION CREME
$50.00

Latisse Patient Consent Form

Thank you! Your medical questionnairehas been submitted successfully.
Please fill out all required fields.

1. Ocular History (Eyes)

Are you currently using any prescription eye drops for Glaucoma or ocular hypertension? (e.g., Lumigan, Xalatan, Timolol)
Have you ever been diagnosed with high eye pressure (Ocular Hypertension) or Glaucoma?
Have you had any eye surgery in the last 6 months (Cataract, LASIK, etc.)?
Do you have a history of eye inflammation (Uveitis or Iritis)?
Do you have any active eye infections or chronic "dry eye" symptoms?
Do you wear contact lenses? (Note: Lenses must be removed before application)

2. Medical History

Do you have any known allergies to Bimatoprost or other prostaglandins?
Are you currently pregnant, planning to become pregnant, or breastfeeding?
Do you have a history of skin sensitivity or eczema on your eyelids?

3. Informed Consent & Risks

Please initial next to each point to acknowledge you understand the potential side effects:

Permanent Pigmentation: I understand that Latisse may cause increased brown pigmentation of the colored part of the eye (the iris), which is likely permanent.
Skin Darkening: I understand that darkening of the eyelid skin may occur but is typically reversible if the product is discontinued.
Hair Growth: I understand that hair growth can occur in any skin area that Latisse frequently touches; I will blot any excess solution.
Common Irritation: I understand that eye redness, itchiness, and dryness are common side effects.

Patient Attestation

I certify that the information provided above is true and accurate to the best of my knowledge. I have been informed of the potential side effects and the proper application technique.

Details
Instantly uncover fresh, new skin, reduce enlarged pores, soften dark spots, dramatically smooth fine facial lines and soften acne and other scars in weeks with this blend of Volcanic Microcrystals suspended in a soothing, conditioning creme. 

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    • Gently polishes skin to an ultra-smooth finish with volcanic microcrystals

    • Reveals fresh, new, healthier-looking skin in seconds

    • Minimizes signs of sun damage, irregular pigmentation, lines, large pores & acne scars

    • Helps revive the skin’s natural barrier as it soothes and conditions the skin

Skin Conditions

Rough Texture | Fine Lines | Large Pores | Acne-Scars | Irregular Pigment \n

Home Care

Generously apply creme to moist skin on the chest, neck, and face. Massage manually or with a microdermabrasion creme applicator for up to 2 minutes. Rinse well. Avoid eye area. Repeat once or twice a week for mild resurfacing, or daily for 3-5 days for more intense resurfacing. For best results, follow with a barrier-repair creme, fluid, or oil. Always suggest the daily use of sunscreen with an SPF 15 or higher when recommending any skin resurfacing program. \n

Ingredients

Pumice | volcanic microcrystals – the smallest of all buffing crystals – gently polish without irritation Green Tea, Chamomile & Licorice | soothing plant extracts calm skin during polishing treatment Jojoba Oil | conditioning oil leaves skin ultra-soft Kukui, Borage & Sunflower Oils | lipid-rich plant oils help revive skin’s natural moisture barrier
Materials + Care

We prioritize quality in selecting the materials for our items, choosing premium fabrics and finishings that ensure durability, comfort, and timeless appeal.
Shipping + Returns

We strive to process and ship all orders in a timely manner, working diligently to ensure that your items are on their way to you as soon as possible.

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