Skip to product information
Wish Charm Necklace
  • Wish Charm Necklace
Wish Charm Necklace
$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
Introducing the Exquisite Wish Charm Necklace Immerse yourself in the resplendent allure of our exclusive Wish Charm Necklace. This opulent piece encapsulates the essence of sophistication and elegance, crafted with meticulous attention to detail. Its understated beauty exudes a timeless luxury that is sure to captivate admirers. Indulge in the sublime charm of this necklace, delicately fashioned with the utmost precision. Adorned with intricate charms that symbolize your deepest desires, it serves as a tangible reminder of your aspirations. Each charm is exquisitely designed, reflecting the epitome of refinement. Made with the utmost craftsmanship, this enchanting necklace incorporates lightweight materials, ensuring effortless comfort throughout the day. It gracefully rests against your neckline, enhancing your allure with an enchanting glimmer that befits its prestigious nature. This captivating accessory effortlessly elevates any ensemble, befitting both formal occasions and intimate gatherings. Arrayed in timeless luxury, the Wish Charm Necklace boasts a transformative power, infusing your every venture with elegance and grace. Allow this exquisite adornment to become an emblem of your unique desires, harmonizing your aspirations with style beyond compare.
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.

You might also like...