- CosmeticRX

Next, let’s go through your health history.

Do you take any prescription or non-prescription medicines?

Yes No

Please describe more

Please list all your prior and current medical problems and surgeries.

Please list all allergies that you have, including allergies to any medications or any supplements, and all other allergies.

Are you allergic to Bimatoprost (the active ingredient in Latisse)?

I am allergic to Bimatoprost I am not allergic to Bimatoprost

I understand that I must stop Latisse one month before becoming pregnant, and I cannot use this product while pregnant or breastfeeding.

I understand I do not understand

Do you have a history of eye problems, such as glaucoma, high eye pressure, macular edema, or an abnormality of the lens?

Yes No

I have read and understand the possible side effects of Latisse, including a risk of irritation at the eyelid margin, eyelid pigmentation, and although uncommon, a possible risk of permanent discoloration of the iris of the eye.

I acknowledge and understand the possible side effects of using this product No, I am not ok with the possible side effects of using this product

I would like to provide additional information / details for my dermatologist.

Yes No

Please describe more

I understand that the prescription can be adjusted between three refill options or paused or stopped at any time. The initial default refill frequency is every month. Refills can be adjusted at any time by clicking refill settings in my dashboard.

I understand I do not understand

All set. Thanks

CosmeticRx dermatologists review your responses 7 days a week. The cost of your brand name prescription medication is the guaranteed lowest price of any US telehealth company – and free shipping is included, and there are never any other charges.

CosmeticRx has the guaranteed lowest price of any US telehealth company for .

Are you a new or existing user to CosmeticRx

I am a new user I am an existing user