Eyelash & Eyebrow Restoration

Evaluation Form

 Have long, thick luscious eyelashes become an essential part of your look?

What is happening with your beauty routine right now, with your normal beauty clinics closed?

WE CAN HELP YOU ACTUALLY GROW YOUR OWN LASHES & EYEBROWS

—– LONGER – THICKER – DARKER —–

With a research backed medical solution to grow

(or regrow where have been lost through use of false eyelashes or over plucking of eyebrows etc)

 or even if lashes or eyebrows have been lost due to medical conditions or medication.

—–

Simple apply our Elev8 Growth Serum once a day, at night before you go to sleep

Read more here…

Or complete the below medical history form to check if suitable for you.

We then contact you for a 10 minute consultation & send your product out direct to your door!

Eyelashes & Eyebrow Regrowth Eval Form
PLEASE CONFIRM YOU ARE 18 YEARS OF AGE OR OLDER? *
WHAT IS YOUR MAIN AREA OF CONCERN? *

WHICH BEST DESCRIBES YOUR EYE LASHES/EYEBROWS

Check all that apply you, or if None of those listed, please provide specific details: *
What was the timeline for the above changes? *
Are you currently using any products on your Eyelashes or Eyebrows *

MEDICAL HISTORY

MEDHEAD ELEV8 EYELASH & EYEBROW GROWTH SERUM IS SAFE FOR MOST PEOPLE.
If however you have certain eye problems or other medical conditions or medication it may not be suitable for you, so please let us know if you suffer from any of the following:
Check all that apply you, or if not listed, provide specific details under Other: *
Note to those who ticked yes for "Are you being treated for Ocular Hypertension and/or Glaucoma?" This does not exclude you from using Elev8, however may require monitoring
Have you had cancer/undergone chemotherapy? *
Do you have HIV/immuno Supression Disease? *
Any known Allergies *

MEDICATIONS

Are you currently taking any medications to treat ocular hypertension and/or glaucoma? *
The active ingredient in Elev8 lowers intraocular pressure, so if you are using IOP lowering medications for ocular hypertension and/or glaucoma, you must tell your eye doctor before you try Elev8, so that they can monitor your eye pressure.

YOUR CONSULTATION BOOKING

Please advise your preferred contact method for your consultation: *
What is your Skype, Facetime or WhatsApp contact details *
What time suits you best? (your consultation will take approx 10-15 minutes): *
If you would like to provide any supporting documents or images related to your issues, please upload here:
Maximum upload size: 516MB