Before Proceeding to the Medical Consultation Form 
please read
CONTRAINDICATIONS /PRECAUTIONS and WARNINGS
and accept the Waiver of Liability
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
 
How To Request  a  VANIQA PHYSICIAN CONSULT:
    1. First read about VANIQA Cream and learn more about its indications, contraindications/precautions and read and agree to the Waiver of Liability.
    2. Next, accurately and truthfully complete and submit a medical consultation questionnaire
    3. 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.
    4. 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:
  • 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.
  • Do NOT us e VANIQA if you are breast feeding.
  • 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.
  • VANIQA is contraindicated if you have extremely sensitive skin or severe inflammatory acne.
  • 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. 
  • 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:
  1. Idiopathic: Hereditary,  normal facial hair increase with aging
  2. Use of Anabolic Drugs or Androgenic Drugs  such as Dilantin (phenytoin), Anavar, Diazoxide, Minoxidil, Cyclosporin, Danazol (for endometriosis)
  3. Acromagaly accompanied by enlargement of hands and feet as well as facial features
  4. Chronic skin irritation can result in increased hair growth
  5. 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
  6. Polycystic Ovary Syndrome -often accompanied by menstrual irregularities and onset of hirsutism around menarche
  7. Androgenic Tumors (malignant & non-malignant) of ovaries or adrenal glands.  Often notice a rapid onset and sudden increase in excessive hair growth
  8. Acanthosis Nigrans Syndrome accompanies by hyperpigmented changes in the skin creases along with insulin resistance
  9. 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:
  1. 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.
  2. It is crucial that you inform your physician and any treating physician that you are using VANIQA.
  3. 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.
  4. 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.
  5. Wait at least 5 minutes until completely dry and then apply your routine skin care products and makeup.
  6. 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.
  7. 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:

  • 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. 
  • If you get the medication in your eyes, rinse immediately with water and contact your regular physician! 
  • Vaniqa has less than a 1% absorption into the bloodstream, therefore here are NO systemic effects when used appropriately
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.
I agree, proceed to Waiver of Liability I disagree
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