Eyelash Growth | Easy Derm

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Terms and Conditions* This field is required.

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Name* This field is required.Please enter your legal name as shown on your driver license.

First Name

Last Name

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Email* This field is required.

example@example.com

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What is your biological sex?* This field is required.

Male

Female

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What is your birthdate?* This field is required.To change the year on a mobile device, click on the year in the calendar

Date

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Which state do you live in?* This field is required.Please select your state.

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Are you breastfeeding, pregnant, or planning on becoming pregnant?

YESNO

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State Calculator

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Which of the following apply to you?

I am experiencing loss of my eyelashes

I am NOT experiencing loss of my eyelashes

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Have you experienced any of the following?

None

Glaucoma, increased ocular pressure, or ocular hypertension

Blurred vision, vision changes, or seeing halo's around lights

History of uveitis or conjunctivitis

Currently experiencing infection of the eyelids

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Have you experienced any of the following?

None

A history of injury to the lens of your eye, such as torn posterior capsule

Current chemotherapy or radiation therapy

Previous eye surgery, including LASIK or cataract surgery

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Have you been prescribed, or used Latisse (bimatoprost) in the past?

YESNO

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Did you at anytime experience any of the following side effects while using Latisse or bimatoprost?

None

Blurry vision

Swelling and redness of your iris or the inside of your eye (uveitis, iritis, intraocular inflammation)

Decreased eye pressure

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Did you at anytime experience any of the following side effects while using Latisse or bimatoprost?

None

Changing of eye color (darkening of light colored eyes)

Swelling of the back of the eye (macular edema)

Other side effects

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In the next sections upload a clear picture of your face, and provide a photo of your government-issued ID to comply with telehealth laws.

Your assigned provider is based on your state of residence. To see our list of providers visit EasyDerm.com/providers.

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Would you like to use your camera or upload pictures?

Use CameraUpload Photos

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Provide a picture of your face. Please ensure that:

1. Your face is well lit and clear

2. Your entire face is visible

3. You're the only person in the photo

4. Nothing is covering your face

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Upload photo of facePlease ensure your entire face is visible to comply with tele-health laws and avoid delay in your treatment.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Photo of FacePlease ensure your entire face is visible to avoid delay in your treatment.

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Identity Verification. Please ensure that:

1. ID card is a valid driver license or passport

2. Photo is clear, and all edges are showing

3. Full name and DOB are visible

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Upload driver license or passportIf you wish to provide your ID at a later time, click "Next" and skip this step.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Driver license or passport

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Please list any medications, vitamins, and supplements you are taking.If none, move onto next question.

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Please list any allergies.If none, move onto next question.

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Please list any medical conditions you have been diagnosed with, and any surgeries you have had.If none, move onto next question.

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Congrats, you're a candidate for our prescription lash growth medication, Bimatoprost 0.03% drops!

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How well does it work? In clinical trials 78% of patients using bimpatoprost saw a significant increase in overall eyelash prominence, and almost all women had lashes that were 106% fuller, 25% longer, and 18% darker!

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How do I use it? After removing make-up and contact lenses, place one drop of the solution onto a topical applicator. Using the applicator, apply a thin layer of solution to the upper eyelid at the lash line - where the eyelashes meet the skin. Blot away excess solution, and be sure not to get any in your eye. Do not apply to the lower eyelid.

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Side effects? Some may experience irritation, or darkening of the upper eyelid skin along the lash line. In most cases, this darkening is reversible when stopped. There is a potential risk for periorbital fat loss, and intraocular pressure changes. There is a potential for increased brown iris pigmentation (brown darkening of the colored part of the eye), which is likely to be permanent. In the clinical trial, the incidence of all side effects, including brown hyperpigmentation of the iris was less than 4%. Do not apply directly into the eyes.

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Attestation

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Pregnancy & Breastfeeding

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Based on the answers you provided we cannot prescribe you eyelash growth treatment through our telemedicine based platform.

It is recommended that you follow-up with your primary care physician.

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Our eyelash growth treatment is limited to certain states, and is currently not available in your area. However, we are planning to launch this service to your state by the end of the year!

We will send you a notification as soon as we're in your area!

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Click submit and start eyelash growth treatment today!

*Prescriptions are not guaranteed, and are only issued after a provider determines that the prescription is medically indicated. We can either arrange for your prescription to be delivered to you, or provide you with the written prescription. If the medical provider determines that you are not a candidate for therapy, then you will be refunded!