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RESCUE GEL
  • RESCUE GEL
RESCUE GEL
$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
Fast-drying, invisible gel that quickly and visibly helps clear breakouts while forming an invisible film to “seal” skin from pollutants and makeup \n

Actions


    • Exfaliates & purifies pores – without irritating side effects

    • Supports skin’s self-repair processes

    • Calms and eases visible redness

    • Seals opening over blemishes to protect from pollutants & makeup

    • Apply makeup in minutes

Skin Conditions

Mild to Severe Acne-Prone | Pustular Rosacea Apply a small amount of gel over the affected pores. It may be applied under or over moisturizer, sunscreen, or makeup, but clean skin is best. Repeat as needed. 

 Ingredients

Betaine Salicylate | natural skin conditioner from sugar beets complexed with keratolytic BHA; provides time-released exfoliating action long after the cleanser is rinsed away 1,3 Beta Glucan | Biological Response Modifier (BRM) from Baker’s Yeast; challenges skin to correct itself \n4-Terpineol | highly purified active fraction of Australia Tea Tree oil; delivers broad-spectrum inhibition of hostile skin flora without irritation or allergens associated with pure Tea Tree oil \nGreen Tea (Camellia Oleifera) | soothes signs of inflammation, including redness. Dipotassium Glycyrrhizate | soothing molecule from licorice; calms on contact \nSulfur | non-irritating, easily absorbed form of sulfur, visibly degreases the skin and controls excess oil \nChlorella Vulgaris Extract | microalgae from Brittany; helps reduce risk of surface scarring Eucalyptus, Wild Thyme, and Sage | pore-purifying essential oil blend \nEucalyptus, Wild Thyme, Sage | pore-purifying essential oil blend
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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