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TRIPLE C&E COMPLEX
  • TRIPLE C&E COMPLEX
TRIPLE C&E COMPLEX
$68.00

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
A blend of three unique, time-released, targeted delivery systems slowly diffuses three stabilized forms of Vitamin C and three forms of Vitamin E throughout the skin, creating a reservoir of vitamins at all levels that helps visually repair years of sun damage within weeks. 

Actions


    • Youthful radiance begins to return within minutes

    • Obvious lines around the eyes, mouth, cheeks, and jawline appear to diminish within weeks

    • The evenness of skin tone starts to improve within days

    • Blackheads and clogged pores begin to clear within days

Skin Conditions

Dry | Lackluster | Lacking Firmness or Elasticity | Frequent Blackheads or Clogged Pores | Deepening Lines Around the Eyes, Mouth, Cheeks, or Jawline. 

Home care

Smooth 1-3 pumps of fluid over clean skin before applying moisturizer, sunscreen, or makeup. It may also be applied to chest and back of the hands. To reduce friction and help prevent redness that can occur during application, warm Triple C&E Complex between fingertips by quickly rubbing hands together, then lightly pat and press product into the skin. If used with other treatments, layer over water-based complexes and under moisturizer. Avoid irritation from strong AHA products by applying Triple C&E Complex during the day and AHAs at night. Avoid the eye area if tearing occurs. \n

Ingredients

Ascorbyl Methylsilanol Pectinate | water-soluble, stabilized, time-released Vitamin C Magnesium Ascorbyl Phosphate | water-soluble, stabilized, time-released Vitamin C Tetrahexyldecyl Ascorbate | lipid-soluble, stabilized, time-released Vitamin C Tocopheryl Acetate | Vitamin E ester keeps skin lipids fresh, protects natural radiance Tocopheryl Linoleate | moisturizing Vitamin E forms a comforting pillow of moisture in the skin for 16-20 hours Tocopherol | antioxidant Vitamin E fights lipid and sebum oxidation, discourages blackheads Bioflavonoids | Vitamin C ‘bridging’ agent, delivers Vitamin C to skin cells to ensure activity Rosehip Seed Oil | helps repair skin’s natural moisture zone and revives radiance from within Dipotassium Glycyrrhizate | powerful soothing molecule from Licorice calms on contact
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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