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FOAMING FACIAL REFINER
  • FOAMING FACIAL REFINER
FOAMING FACIAL REFINER
$39.00

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
Microbeadlets of Ecuadorian Ivory Palm Seeds and Jojoba are suspended in a deep cleansing gel and blended with invigorating essential oils to quickly smooth the rough, oily skin of dead cells and impurities clogging pores. 

Action


    • Refines enlarged pores

    • Smoothes the rough, uneven texture common to oily skin in seconds

    • Dissolves unwanted oil as it eases off dead cells that can block pores

Skin Conditions

Normal | Oily | Clogged Pores | Rough Texture \n

Home Care

Massage a moderate amount of Foaming Facial Refiner over wet skin for approximately one minute. Rinse well with warm water. \n

 Ingredients

Ecuadorian Ivory Palm Seeds & Jojoba | perfectly round microbeadlets ease off unwanted skin cells Silica | eco-friendly micro grains gently polish away surface cells Jojoba Beads | gently smoothes rough, uneven texture Yucca | natural cleanser removes oils and impurities without drying surface skin Green Tea | standardized for natural soothing antioxidant calms skin during exfoliation Glycerin | deeply hydrating keeps skin moist during cleansing and exfoliation
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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