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 Advanced Women's Hair Removal 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 VANIQA Cream |
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How
To Request a VANIQA PHYSICIAN CONSULT:
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First read
about VANIQA 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 VANIQA prescription with 6 refills which
can be filled at any U.S. pharmacy of your choice.
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This physician
evaluation is RISK-FREE. If VANIQA is not appropriate for you
there is No charge. The initial consultation fee for the physician
evaluation is only $49.95.
CONTRAINDICATIONS
VANIQA
is the only FDA -approved prescription medication for the treatment of
excessive facial hair in women, but VANIQA cream use has not
been thoroughly evaluated in a EVERY situation. VANIQA
use is CONTRAINDICATED and must NOT be used in anyone with the following
conditions:
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Do NOT use
VANIQA if you are pregnant, attempting to become pregnant, or at a high
risk of becoming pregnant. Vaniqa is a Pregnancy Category C which means
that animal studies have shown that it has an adverse effect on the fetus
but there are no adequate studies in humans.
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Do NOT us e
VANIQA if you are breast feeding.
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Do NOT use
VANIQA if you are allergic to any of the ingredients: anhydrous eflornithine
hydrochloride, ceteareth-20, cetearyl alcohol, dimethicone, glyceryl stearate,
methylparaben, mineral oil, PEG-100 stearate, phenoxyethanol, propylparaben,
stearyl alcohol and water.
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VANIQA is contraindicated
if you have extremely sensitive skin or severe inflammatory acne.
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We will not
prescribe VANIQA to anyone under the age of 18. Also Vaniqa should NOT
be used by pregnant women, women attempting to become pregnant or women
who are breast feeding.
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VANIQA is NOT
approved for use by Men!
IMPORTANT
WARNINGS
PARTIAL
LIST OF UNDERLYING CAUSES OF HIRSUTISM
Hirsutism is the medical
condition of excessive hair growth. This hair growth may be hereditary
or due to just normal aging process or as a result of taking certain medications
such as Dilantin or Danazol etc. But Hirsutism may be a sign of SERIOUS
UNDERLYING MEDICAL CONDITIONS. VANIQA will be effective in treating
the excessive hair growth regardless of the cause, but it DOES NOT TREAT
THE UNDERLYING CONDITION. In order to be treated by Medical Wellness
Center's Advanced Women's Hair Removal Physicians you MUST BE CONCOMITANTLY
FOLLOWED BY YOUR REGULAR TREATING PRIMARY CARE PHYSICIAN and have routine
physical exams. Medical Wellness Center does NOT diagnose
or treat any underlying conditions. It is solely your responsibility
to seek routine and regular medical treatment for all pre-existing and
newly arising medical conditions. FAILURE TO DO SO CAN RESULT IN
SEVERE ADVERSE HEALTH CONSEQUENCES AND EVEN DEATH:
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Idiopathic:
Hereditary, normal facial hair increase with aging
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Use of Anabolic
Drugs or Androgenic Drugs such as Dilantin (phenytoin), Anavar, Diazoxide,
Minoxidil, Cyclosporin, Danazol (for endometriosis)
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Acromagaly
accompanied by enlargement of hands and feet as well as facial features
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Chronic skin
irritation can result in increased hair growth
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Cushings Syndrome
- excess hair on face, neck, chest, upper body obesity, rounded face, fat
around neck, thinning of arms and legs, bruise easily, stretch marks
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Polycystic
Ovary Syndrome -often accompanied by menstrual irregularities and onset
of hirsutism around menarche
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Androgenic
Tumors (malignant & non-malignant) of ovaries or adrenal glands.
Often notice a rapid onset and sudden increase in excessive hair growth
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Acanthosis
Nigrans Syndrome accompanies by hyperpigmented changes in the skin creases
along with insulin resistance
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Non-Classic
Adrenal Hyperplasia characterized by hirsutism, acne, oligo or amenorrhoea
IMPORTANT
PATIENT INFORMATION
HOW TO USE VANIQA Cream for
Removal of Unwanted Facial Hair:
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VANIQA should
be applied to the affected areas of the face and chin only as directed
by a physician. It is for external/topical use only and is very safe
when use as directed. VANIQA is NOT to be used on other parts of the body
or by men.
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It is crucial
that you inform your physician and any treating physician that you are
using VANIQA.
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VANIQA should
be applied to the face twice a day, applications should be approximately
8 hours apart, 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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Apply the VANIQA
cream to the affected areas of your face and chin cream avoiding
contact with the eyes, mouth, and mucous membranes. Thoroughly
rub the cream in until it is completely absorbed. Wash hands after use.
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Wait at least
5 minutes until completely dry and then apply your routine skin care products
and makeup.
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There are NO
medical studies on the interaction of VANIQA cream and other topical medications.
Therefore if you are prescribed any other topical medications for the face
ALWAYS check with the prescribing doctor about its compatibility with VANIQA.
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Improvement
in appearance is gradual over the course of therapy. During the initial
weeks you will have to continue to use your regular methods of hair removal.
By 8 weeks you may start to notice that you are removing hairs less frequently
and eventually continual use of VANIQA will prevent facial hair growth.
In some individuals up to six months of therapy may be required before
the effects are seen.
ADVERSE REACTIONS
- SIDE EFFECTS:
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The majority
of patients using Vaniqa experience no side effects. Vaniqa is fragrance-free
and any side effects are mild if any. The side effects when used
topically as directed are limited to possible stinging, burning or itching
sensation, redness, folliculitis (hair-bumps) and acne. Less than
1% of users experience any side effects. If irritation continues
stop use of Vaniqa and contact your doctor.
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If you get
the medication in your eyes, rinse immediately with water and contact your
regular physician!
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Vaniqa has
less than a 1% absorption into the bloodstream, therefore here are NO systemic
effects when used appropriately
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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 VANIQA therapy. Also, that I am aware of the side effects ! I
fully understand that excessive facial hair can be due to a number
of serious underlying medical conditions. Although VANIQA may
treat the excess hair growth it does NOT treat the underlying condition
which if left untreated or undiagnosed can result in DEATH! I understand
that it is solely my responsibility to seek diagnostic and medical treatment
for any underlying medical conditions from my own regular primary care
physician. |
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