The treatment prescribed by your clinician enhances the length, thickness, and darkness of eyelashes in as little as 8 weeks, with full results usually seen at 16 weeks. Apply once a day to the skin of the upper eyelid margins at the base of the eyelashes using the provided disposable applicators, and referring to the instructions. After 16 weeks you can reduce the use of Lumigan (Bimatroprost 0.03%) to twice per week. For some users, 3x Times per week might be necessary to maintain their results.

Do not apply to the lower eyelid, elsewhere or more often than once daily.

I understand to discard the applicators after a single-use, to soak up excess solution after application.

I will follow the instructions to apply Lumigan (Bimatoprost 0.03%) to minimise possible side effects and minimise direct eye contact.

Side effects include: darkening of the eyelid skin & reduced periorbital fat, which may or may not be reversible. Increased brown pigmentation of the iris (coloured part of the eye) may be permanent and occurs when the medication gets into the eye regularly. Increased hair growth in other areas of your skin that the medication touches is possible.

Common side effects: eye redness (3.6%), itchy eyes (3.6%), skin hyperpigmentation (2.9%) and Irritation to the surface of the eyes.

Other side effects include: Iris colour changes/darkening (very rare), burning sensation (eyelid), redness around the eye, eye swelling, eyelid irritation, eyelid puffiness (oedema), eyelid itching, iris hyperpigmentation, lacrimation increased (increased tears), madarosis and trichorrhexis (temporary loss of a few eyelashes to loss of sections of eyelashes, and temporary eyelash breakage, respectively), rash (including macular, erythematous, and pruritic limited to the eyelids and periorbital region), skin discolouration (periorbital), and vision blurred.

I have read the above information and understand the possible side effects that may occur with the use of Lumigan (Bimatoprost 0.03%).

I will inform my GP and Eye Doctor that I'm using Lumigan Eyelash Serum.

If I experience any of the side effects, I will stop using the drug and I will get in touch with my GP or Dr Cosmetic Clinic.

The product is only intended for my personal use and I will not allow any other person to access the prescribed treatment.

Repeat prescription will not be given if your clinician feels you are not using the product as prescribed.

I acknowledge that Lumigan (Bimatoprost 0.03%) is prescribed in my name, and therefore I cannot return it once purchased. Therefore, I won’t be able to get a refund if I change my mind or find the drug not suitable.

I acknowledge that provision of treatment does not guarantee any outcome and that no result is a possible outcome.

I acknowledge that Dr Cosmetic Clinic will not be liable for any loss, damage or delay that results from:

• you, having to collect an item that relates to this service that needs to be collected from a post office because there was no one to sign for delivery at the shipping address you gave.

• you, failing to collect any item that is waiting for collection at a post office.

• Someone signing for a delivery related to this service at the shipping address that you gave, yet fails, for whatever reason, to deliver the item to you in person.

I acknowledge that Dr Cosmetic Clinic will not be required to send a repeat order of treatment to a patient when treatment has been signed for at the delivery address and, for whatever reason, treatment has not been started or completed by the patient.

I consent to share my personal details with the dispensing pharmacy.