TERMS AND CONDITIONS
YOU MUST CAREFULLY REVIEW THIS INFORMATION AND SIGN THIS DOCUMENT BEFORE WE CAN PROCEED WITH TREATMENT AND SHIPMENT OF THIS PRODUCT. YOU ACKNOWLEDGE THAT YOU WILL FOLLOW THE INSTRUCTION STATED BELOW.
1.1. You request and consent that You will receive Latisse (bimatoprost ophthalmic solution) which is a prescription product, FDA approved to treat hypotrichosis (inadequate or not enough eyelashes). You agree that You are, and will be under the care of another health care provider for all other conditions. LatisseDoctor.com can work in conjunction with, but cannot replace, regular primary care physicians, such as general practitioners or other specialists in family medicine or internal medicine. You understand the physician with Latisse Doctor only prescribe Latisse for the treatment of lengthening, thickening, and darkening eyelashes. We do not accept or bill insurance for this program.
2.1. Hypersensitivity. You understand that Latisse® is contraindicated in patients with hypersensitivity to bimatoprost or any other ingredient in this product.
2.2. Pregnancy. You understand that use of Latisse® is absolutely contraindicated during pregnancy andbreastfeeding while there are no adequate and well controlled studies for bimatoprost ophthalmic solution 0.03% administration in pregnant and/or nursing women;Latisse® should not be administered during pregnancy since the potential benefit does not justify the potential risk to the fetus.Nursing mothers should not take Latisse® since many drugs are excreted in human milk.You understand that it is your responsibility to inform LatisseDoctor.com if You are pregnant, could become pregnant, or should become pregnant during the course of the treatments.
2.3. Contact Lenses. You understand that Latisse® may be absorbed by soft contact lenses. Contact lenses should be removed prior to application of solution and may be reinserted 20-30 minutes following its use.
Possible Side Effects
3.1. YOU UNDERSTAND THAT THERE ARE ASSOCIATED RISKS AND UNINTENDED SIDE EFFECTS WHILE USING LATISSE® AS THERE ARE WITH ALL OTHER MEDICATIONS. THESE POSSIBLE SIDE EFFECTS OF LATISSE® INCLUDE BUT ARE NOT LIMITED TO RISKS STATED BELOW.
3.2. Risks. You understand there is a risk of itching, increased blood in the eye, hyperpigmentation of the skin, irritation, conjunctival hyperemia (redness of eyes), itchy eyes, dry eyes, redness, allergic reaction, visual disturbances, and eye pruritus.
3.3. Infection. You understand thatinfections can occur which in most cases are easily treatable but in rare cases a permanent scarring in the area can occur.
3.4. Iris Pigmentation. You understand thatincreased iris pigmentation mayoccurred. You should be advised that the potential for increased brown iris pigmentation is likely to be permanent should this side effect occur. Iris color changes may not be noticeable for several months to a year.
3.5. Lid Pigmentation. You understand that Bimatoprost has been reported to cause pigment darkening of the eyelid. This side effect has been reported to be reversible upon the discontinuation of the treatment.
3.6. Intraocular Inflammation. You understand that Latisse® should be used with caution in individuals with active intraocular inflammation (uveitis) because the inflammation may increase. If you are using LUMIGAN® ophthalmic solution or other products for elevated intraocular pressure (IOP), or if you have a history of abnormal IOP, you should only use Latisse® under the close supervision of you physician.
3.7. Macular Edema. You understand that Latisse® may causeswelling of the small area of the retina responsible for central vision. The edema is caused by fluid leaking from the retinal blood vessels.
3.8. YOU UNDERSTAND AND AGREE THAT IF ANY OF THE ABOVE SIDE EFFECTS OCCUR OR YOU BEGIN EXPERIENCING OTHER SIDE EFFECTS NOT MENTIONED IN THIS DOCUMENT THAT COULD BE REASONABLY ASSOCIATED WITH YOUR USE OF LATISSE® YOU WILL DISCONTINUE LATISSE® USE IMMEDIATELY AND YOU AGREE TO IMMEDIATELY CONSULT YOUR CONDITION WITH YOUR HEALTH CARE PROVIDER.
3.9. IF YOU BEGIN EXPERIENCING A NEW OCULAR CONDITION (SUCH AS TRAUMA, OR INFECTION), EXPERIENCE A SUDDEN DECREASE IN VISUAL ACUITY, HAVE AN OCULAR SURGICAL PROCEDURE, OR DEVELOP ANY OTHER OCULAR REACTIONS (ESPECIALLY CONJUNCTIVITIS AND EYELID REACTIONS) YOU AGREE TO IMMEDIATELY CONSULT YOUR CONDITION WITH YOUR HEALTH CARE PROVIDER CONCERNING THE CONTINUED USE OF LATISSE®.
Directions for Use
4.1. YOU UNDERSTAND THAT LATISSE® MUST BE USED EXACTLY AS DIRECTED TO REDUCE THE RISK OF COMPLICATIONS AND SIDE EFFECTS AND THAT ANY MISUSE OF LATISSE® COULD INCREASE THE CHANCES OF UNINTENDED SIDE EFFECTS.
4.2. You agree to follow these instructions:
- The Latisse bottle must be kept intact during use.
- Place one drop on the single use per eye applicator.
- Bottle tip should never be allowed to contact any other surface to avoid contamination.
- Sterile applicators may only be used on one eye and then discarded. Reuse of applicators
increases the potential for contamination and infection.
- Latisse should only be applied to the skin of the upper eyelid margins at the base
of the eyelashes. Do not apply Latisse to bottom lashes.
- Do not use Latisse more than once per day. Additional application will not increase
results but will increase the risk of possible complications and side effects.
- Upon discontinuation of Latisse eyelash growth is expected to return to its pre-use
- Do not use Latisse on any other areas of the body. Studies have not been performed
as to the safety and effectiveness in any area other than the eyelashes.
- It is possible for hair growth to occur in other areas of your skin that Latisse
frequently touches. Any excess solutions outside the upper eyelid margin should
be blotted with a tissue or other absorbent material to reduce the chance of this
- It is possible for a difference in eyelash length, thickness, fullness, pigmentation
(darkness), number of eyelash hairs and/or direction of eyelash growth to occur
between eyes (e.g., results may vary for each eye). These differences, should they
occur, will usually go away if you stop using Latisse.
6.1. Depending on weight, we will ship your order via the USPS First Class or Priority Mail w/ Delivery Confirmation. Orders shipped to Businesses, Multi-family dwellings, or totaling more than $200 will automatically be sent with requiring signature confirmation for your own security.
6.2. You accept that the USPS's Delivery or Signature Confirmation is a PROOF of Latisse® delivery to the address You provide. You also understand and agree that once the package enters the postal system the US postal service will be solely responsible for any loss or damage to the package.
6.3. You understand and agree that once your order is shipped, You cannot return or refuse your order for Latisse® for any reason because it is a prescription product written exclusively for You.
6. Your Consent and Acknowledgment
6.1. You acknowledge that prior to your treatment, You have fully disclosed any medical conditions or diseases such as: pregnancy, breastfeeding, history of glaucoma, aphakia (absence of lens in the eye), macular edema, ocular inflammation, hypersensitivity to Latisse® (or bimatoprost), or other serious medical condition. Any contraindications for the use of Latisse® have been fully disclosed to me. You acknowledge that You have been true and correct in revealing any condition that may have an effect on this treatment.
6.2. You will also inform LatisseDoctor.com of any changes in my medical history, current medications and/or any changes relevant to this procedure prior to any future treatments.
6.3. With respect to Latisse®, You waive your option to be seen in person and agree to use Latisse® as intended and directed.