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Lash & Brow Enhancer with WideLash™
  • Lash & Brow Enhancer with WideLash™
  • Lash & Brow Enhancer with WideLash™
Lash & Brow Enhancer with WideLash™
$69.00

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

Eyes are the windows to the soul. Use this product to draw the eye to your inner beauty by surrounding your eyes with luscious lashes and brows. Agelyss Lash & Brow Enhancer with WideLash™ supports the growth of stronger, longer, and thicker hair for healthier, youthful-looking lashes and brows.

Benefits Of This Product

  • Thickens, Lengthens & Strengthens Hair
  • Conditions Lashes & Brows For Lush Results
  • Extends The Active Phase Of The Hair's Growth Cycle
  • Restores Brittle Hair & Protects Against External Damage
  • Secures Hairs At Their Roots & Prevents Premature Breakage

WideLash™ - Lengthens and strengthens lashes and brows
Fision® KeraVeg18 - Rapidly boosts, lifts, curls, and strengthens beautiful lashes.
Regu®-Fade - Visibly enhances lashes and brows.
AnaGain™ - Reactivates hair growth for naturally thicker hair.
Pentavitin® - Strengthens lash and brow follicles with instant, deep hydrating action.

Water, Propylene Glycol, Glycerin, Panthenol, Biotinoyl Tripeptide-1, Xanthan Gum, Sclerocarya Birrea, Seed Oil, Pisum Sativum (Pea) Sprout Extract, Wheat Amino Acids, Saccharide Isomerate, Soy Amino Acids, Arginine HCl, Ubiquinone, Serine, Threonine, Resveratrol, Phenoxyethanol, Sodium Benzoate, Squalane, Polysorbate 80, Citric Acid, Sodium Citrate, Iodopropynyl Butylcarbamate, Potassium Sorbate, Tocopheryl Acetate (Vitamin E), Diazolidinyl Urea, Tetrasodium EDTA.

Step 1: As part of your nighttime routine, apply Agelyss® Lash & Brow Enhancer with WideLash™ to eye lashes and brows, after your usual skin care regimen. Make sure your lashes and brows are dry before application. Never apply the product (or any other beauty product) with dirty hands.

Step 2: Dip the applicator once, removing any excess serum. For the lashes, apply a thin layer along the root of the upper lash line with the applicator brush.  Apply from the inner to the outer corner, just like you would with an eyeliner. For the brows, apply along the root of the brow and sweep along the entire eyebrow.

Step 3: Allow the Agelyss® Lash & Brow Enhancer with WideLash™ to dry and fully absorb before applying other products.
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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