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Medical History Requirement (required to order Latisse online)

Personal Information (all fields are required)

Medical Information & Consent (all fields are required)

Yes, I have reviewed all the information on the Patient Information page.
Glaucoma patients: please note! In some cases, Latisse can still be used safely if you've been diagnosed with IOP or Glaucoma; however, if you are currently being treated for this condition, you can't order Latisse online until we have medical clearance from your eye physician.

Release of Liability

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Consent to treat

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