Lumigan®
EYELASH Serum

Available on doctor prescription only

lashes-icon-isolated-on-white-background

Please complete your

online medical questionnaire

Only available for 18 year-old and above living in the UK

Please complete the following medical questionnaire if you are one of the therapists working in one of our clinics. Your details will remain confidential and will only be accessible by Dr Cosmetic Clinic. Your details will be checked by the doctor before dispatching the Eyelash serum to your address. You may be contacted by the doctor if further information is needed. You will have a £50 discount on the product as we value therapists helping us in the clinic. We won't be taking the payment online, we will send you the payment instructions once you submit the form.

 

arrow&v
1) Are you at least 18 years of age and living in the UK?
2) Are you currenly taking any eye drops?
3) Have you ever suffered from or received treatment for any eye conditions, including active intraocular inflammation, glaucoma or macular oedema?
4) Are you currently pregnant or breastfeeding, or do you plan to become pregnant or breastfeed over the treatment course?
5) I agree that only the above named person will use Lumigan Eyelash Serum prescribed by Dr Cosmetic Clinic and that all the information I have given are true to the best of my knowledge and that I have not withheld information that could potentially be judged as relevant to a Doctor
arrow&v

   Terms & Conditions

  • 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 use the Lumigan (Bimatroprost 0.03%) every other day.

  • 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, which may or may not be reversible. Increased brown pigmentation of the iris (coloured part of the eye) which is likely to 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.

Thanks for submitting!