Top Health Center

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Upload Past Medical Records *

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One Time Consulting Charges: $49.99 (USD)

The above payment is for consultation only and does not cover the cost of your medication. Top Health Center will only send your prescription to your pharmacy of choice.

1 - What sort of results are you looking for? *

2 - Are you currently using any medication directly in your eyes?*

3 - Have you ever used any prescription or over-the-counter eyelash treatments?*

4 - Was your past treatment effective?

5 - Do any of the following currently apply to you?*

6 - Are you currently breastfeeding, currently pregnant, or may become pregnant?*

7 - Do any of the following currently apply to you?*

8 - Please list any additional medical conditions, surgeries, or hospitalizations you have had.

9 - Do you take any medicines, vitamins, or supplements?

10 - Please list any allergies you have.

11 - Is there anything else related to the treatment that you'd like to ask or discuss with your medical provider?

12 - Do you have a preferred treatment?*

13 - Do you have a preference on how often you'd like your medication?*

14 - Please enter preferred pharmacy information.*

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