Before Proceeding
to the Medical Consultation Form
please read
CONTRAINDICATIONS
/PRECAUTIONS and WARNINGS
and accept the Waiver
of Liability
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In
order for Medical Wellness Center Skin Care Physicians to provide you with
the best care, you need to reply honesty to all questions and you need
to understand any and all contraindications, risks and side effects
associated with RENOVA Cream |
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To Request
a RENOVA PHYSICIAN CONSULTATION :
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First read
about RENOVA Cream and learn more about its indications, contraindications/precautions
and read and agree to the Waiver of Liability.
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Next, accurately
and truthfully complete and submit a medical consultation questionnaire
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Your medial
consultation will be reviewed by one of our Physicians and if approved
you will receive a RENOVA (generic
tretinoin 0.05% cream 60 gm tube) prescription
with 6 refills.
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This physician
evaluation is RISK-FREE. If RENOVA is not appropriate for you
there is No charge. The initial consultation fee for the physician
evaluation is only $49.95.
CONTRAINDICATIONS
RENOVA is the
only FDA -approved prescription medication for the treatment of skin aging,
but RENOVA cream use has not been thoroughly evaluated in a number
of
situations. RENOVA use is CONTRAINDICATED and must NOT be used in
anyone with the following conditions:
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RENOVA is contraindicated
in anyone with moderate to heavily pigmented skin. RENOVA is contraindicated
in Black and Brown skin persons and can result in hyperpigmentation.
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RENOVA
is contraindicated in patients with eczema, any other chronic skin condition
or pre-existing skin disorders, actinic keratoses , or history of skin
cancer!
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Do NOT use
RENOVA if you are sunburned, or if you have eczema or other chronic skin
conditions.
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RENOVA is contraindicated
in anyone who is inherently sensitive to sunlight.
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Drug Interactions:
RENOVA is contraindicated in anyone who is taking drugs known to be photosensitizers
such as thiazides (sulfa-containing diuretics commonly used to treat high
blood pressure),diurectics, amiodarone, tetracyclines or quinolone
antibiotics, fluoroquinolones, phenothiazines ( used to treat serious emotionnal
problems), sulfonamides, sulfa-drugs of any kind and minoxidil. (If
unsure, before submitting a medical consultation, check with your
pharmacist and/or personal physician about the medications you are taking)
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Do NOT use
RENOVA if us are using minoxidil and any skin medication, soaps, cleansers,
cosmetics, any facial products that may be drying or irritating to the
skin. Benzoyl peroxide should not be applied at the same time as
this medication.
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RENOVA is contraindicated
in anyone being treated with Accutane, Retin-A, Retin-A Micro, Tretinoin,
isotretinoin preparation or other Vitamin A product.
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RENOVA is contraindicated
in anyone who is pregnant, or is attempting to become pregnant or at a
high risk of getting pregnant, and in anyone breast feeding. Oral
tretinoin in extremely high doses in animal studies has been shown to be
teratogenic (having an adverse effect on an unborn fetus). The teratogenicity
of topical tretinoin has not been established.
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A history of
hypersensitivity to any of the components or ingredients of RENOVA
cream contraindicates usage: to tretinoin or Vitamin-A or any
of the inactive ingredients: RENOVA cream contains 0.05%
tretinoin w/w in a water in oil emulsion formulation consisting of
light mineral oil, NF; sorbitol solution, USSP; hydroxyoctacosanyl hydroxystearate;
methoxy PEG-22/dodecyl glycol copolymer: PEG-24/dodecyl glycol copolymer;
stearoxytrimethylsilane and steary alcohol; dimethicone 50 cs; methylparaben,
NF; edate disodium, USP; quateernium-15; butylated hydroxytoluene, NF;
citric acid monohydrate, USP; fragrance; and purified water, USP.
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Absolutely
no one under the age of 18 should use RENOVA cream.
IMPORTANT
WARNINGS
PRECAUTIONS
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RENOVA
should only be used as part of a comprehensive skin care and sun avoidance
program that includes the use of effective sunscreens. WHEN USING
RENOVA ONE MUST USE A SUNBLOCK EVERY SINGLE DAY REGARDLESS OF THE WEATHER.
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RENOVA
makes the skin more sensitive to sun and one is more susceptible to get
a sun burn. While using RENOVA one needs to avoid or minimize sunlight
exposure. Do NOT use a sun lamp. Patients must use sunblock
with a minimum of SPF of 15 and protective clothing while using RENOVA.
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RENOVA cream
is for TOPICAL use only! RENOVA must be kept out of eyes, mouth,
angles of the nose and mucous membranes.
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Patients with
Sunburn must not use RENOVA until the sunburn has completely cleared. Do
NOT apply RENOVA on sunburn or eczema or another other serious skin condition.
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When using
RENOVA weather extremes such as wind or cold may be more irritating.
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Do NOT use
larger amounts of medication than recommended. Doing so will NOT
lead to more rapid or better results and may cause marked redness, peeling
or discomfort and to the same side effects as those associated with excessive
oral intake of Vitamin A.
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Use mild cleansers
and do NOT use astringents and toners or other skin or cosmetic products
with high concentrations of alcohol. Alcohol has a drying effect
on the skin and can increasing the drying and irritation effects of tretinoin.
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If you have
acne, using RENOVA may initially seem to make your acne worse because Tretinoin
unplugs acne follicles and brings acne pimples to the surface. The
stronger form of Retin-A is an acne treatment.
CONTRAINDICATIONS while using
RENOVA:
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While using
RENOVA do NOT use topical medications, medicated or abrasive soaps, shampoos,
cleansers, cosmetics with a strong drying effect, or products with high
concentrations of alcohol. Astringents, spices or lime, permanent
wave solutions, electrolysis, hair depilatories or waxes and products that
may irritate the skin should be use with CAUTION in patients being treated
with RENOVA because they may increase irritation.
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While using
RENOVA the simultaneous use of any facial product that may be drying
especially alcohol containing astringents and toners is contraindicated.
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Alcohol containing
facial products and Benzoyl Peroxide must NOT be used at the same time
as RENOVA.
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Precaution:
Discontinue use of RENOVA for 3 -4 weeks before irritating procedures
such as electrolysis or waxing.
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Do NOT sunbathe
or using tanning beds or sun lamps while using Renova!
ADVERSE REACTIONS - SIDE
EFFECTS:
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Local reactions
at the site of application, such as peeling, dry skin, burning, stinging,
redness and itching, occur in almost all subjects during therapy
with RENOVA. These signs and symptoms are usually of mild to moderate
severity and generally occurred early in therapy. If the degree
of local irritation warrants, patients should use less medication, decrease
the frequency of application, discontinue use temporarily or discontinue
use altogether.
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If drug sensitivity,
chemical irritation or a systemic adverse reaction develops, use of
RENOVA should be discontinued and you should check with your regular physician.
IMPORTANT
PATIENT INFORMATION
HOW TO USE RENOVA:
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RENOVA should
be applied to the face and only used as directed by a physician.
It is for external/topical use only and is very safe when use as directed.
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It is crucial
that you inform your physician and any treating physician that you are
using RENOVA especially if you are considering any micropeels, chemical
peels, laser peels, skin resurfacing or any facial.
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RENOVA should
be applied to the face once a day before bedtime using only a pea-sized
amount. Do NOT use more frequently or in larger amounts. Using larger amounts
than recommended will NOT lead to better or quicker results and will only
result in severe local skin irritation.
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In the evening,
first wash your face with a mild non-soap cleanser and pat
skin dry waiting about 10 - 15 minutes before applying
a pea-sized amount of RENOVA cream. Lightly cover your entire
face with this amount avoiding contact with the eyes, mouth, mucous membranes
and the angles of the nose. One may feel a transitory feeling of
warmth or slight stinging. Wash hands after use.
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Afterwards
apply a moisturizer or an alpha-hydroxy acid preparation to help counteract
any dryness.
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In the morning
you should follow a complete skin care regimen and at a minimum apply a
moisturizer and SUNBLOCK! One must use SUNBLOCK daily!
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When first
beginning treatment with RENOVA apply every other night or even every third
night depending on whether you skin becomes too red or dry.
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Skin improvement
in texture and pigmentation and a mitigation of fine wrinkles occurs gradually
over the course of therapy. In some individuals up to six months of therapy
may be required before the effects are seen.
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I DO NOT HAVE ANY OF THE
ABOVE CONTRAINDICATIONS:
By accepting "I Agree" means that
you have read the above contraindication, precautions and warnings and
honestly acknowledge that you do not have any of the above contraindications
to RENOVA therapy. Also, that I am aware of the side effects and
that if using RENOVA one must use a SUNBLOCK every day! |
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