• Lash Information & Consent Form

    Thank you for choosing Selfie By SK. Please take a few minutes to fill out this form.
  • Format: (000) 000-0000.
  • How did you hear about us?*
  • Do you have any allergies or sensitivities to latex?*
  • Have you had any chemotherapy treatments within the last 6 months?*
  • Are you currently taking any medication such a (Thyroid, Retin-A, or Accutane etc?)
  • Do you wear contact lenses?

  • I agree to have eyelash extensions applied to my natural eyelashes and/or removed. By signing this agreement, I consent to the placement and/or removal of the eyelash extensions by a licensed eyelash extension professional.

    I understand that in rare occasions there are risks associated with having artificial eyelashes and eyelash extensions applied to or removed from my natural eyelashes.

    I further understand that in rare cases as part of the procedure eye irritation and discomfort could occur. I agree that if I experience any of these conditions with my lashes that I will contact the lash tech that performed this procedure as it may be beneficial to have the eyelashes removed.

    I understand and agree to the after-care instructions provided by the certified eyelash extension professional for the use and care of my eyelash extensions. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelash extensions to fall out prematurely and/or decrease the time the lashes will last.

    I understand that Selfie By SK requires masks during all lash and brow services due to working in close proximity of our client.

    I understand and consent to having my eyes closed and covered for the duration of approximately 60-120 minute procedure. Times may vary depending on the type of service.

    I understand that by coming to an appointment with little to no lashes remaining I will be charged for a full set.

    I understand that a full set is approximately 120 minutes and a fill is 60-90 minutes and that if I am late to an appointment my session will still end at the allotted time and I will pay the original price.

    I understand that my lash tech will only do what is possible in the allotted time frame, and if a fuller look is desired I will need to book a follow up appointment at an additional fee.

    I understand that if I show up more than 15 minutes late to my appointment the lash tech may cancel my appointment and charge my card a late fee of $50.

    I understand that I need to cancel or reschedule all future appointments within 24 hours of the designated appointment time, anything out of that time frame may result in a charge of $50.

    I understand that If I am a no call/no show I may be charged $50 and will need to pay in full prior to booking my next appointment.

    I understand that children/pets and extra guests are not allowed in the studio at the time of my appointment.

    I understand that if my results are not to my liking/or an allergic reaction occurs my lash tech will remove my eyelashes complimentary, however no refunds will be given.

    I understand that my lashes must be properly washed in order to maintain ideal retention and I will show up (eye makeup free) for all future appointments, otherwise a $10 cleaning fee will accrue.

    I understand that a photo or video may be taken during my eye lash appointment for social media, marketing and advertising for Selfie By SK.

    I agree to the following eyelash extension follow-up and maintenance instructions:

    - No waterproof mascara or oil based products around the eye area.
    - No water should come in contact with the eye area for 24 hours after application.
    - No tinting or perming of eyelash extensions.
    - No pulling or rubbing of the eyelash extensions.

                                                                                                                       

    Brow Service Consent 

    Please arrive to your brow appointment with clean skin. Gentle exfoliation is recommended 48 hours prior to your wax appointment, but not within 24 hours of your brow session. Do not apply lotions, oils, deodorants, fragrances, or other skin care products prior to your service.

    Some common contraindications to be aware of are as follows:

    24 hours PRIOR to your service DO NOT:
    - Use a tanning bed with UV lights
    - Spray tan
    - Exfoliate with abrasive scrubs or use Alpha Hydroxy Acid (AHA) chemical serums

    24 hours AFTER your service DO NOT:
    - Wet the service area
    - Use lotions, serums, or other skincare treatments
    - Exfoliate. Please wait 48 hours to begin exfoliating the area.

    ** Consult your physician prior to your appointment if you are taking medications that cause thinning of the skin (such as Retin-A and Accutane) or photosensitivity, or if you are being treated for diabetes or cancer.

    • I understand that removing hair by the root can have certain side effects, such as skin redness, swelling, and tenderness.
    • I understand that if I show up more than 10 minutes late to my appointment the stylist may cancel my appointment.
    • I understand that I need to cancel or reschedule all appointments within 24 hours of the designated appointment time, anything out of that time frame may result in a late cancellation fee of $50 or 100% of the service.
    • I understand that If I am a no call/no show I may be charged up to $50 and will need to pay in full prior to booking my next appointment.


    I have read the above information and if I have any concerns, I will address these with my service provider. I give permission to my service provider to perform the brow procedure we have discussed and will hold them harmless from any liability that may result from this treatment. I understand my service provider will take every precaution to minimize or eliminate negative reactions as much as possible. I have read and understand the pre and posttreatment care instructions, as well as the medical contraindications. I am willing to follow the home care regimen recommended by my service provider that can minimize or eliminate any negative reactions. In the event that I may have additional questions or concerns regarding my treatment, I will consult my esthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures.

    I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the service provider responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.

    Arbitration Agreement
    BY SIGNING THIS CUSTOMER WAIVER AND RELEASE AGREEMENT, I THE CLIENT, CERTIFY THAT I KNOWINGLY AND VOLUNTARILY RELEASE SELFIE BY SK AND ITS DIRECTORS, OFFICERS, OWNERS, EMPLOYEES, AGENTS AND REPRESENTATIVES FROM ANY AND ALL CLAIMS FOR DAMAGES FOR PERSONAL INJURY ARISING FROM THE APPLICATION AND USE OF SEMI-PERMANENT EYELASH EXTENSIONS, INCLUDING ANY DAMAGES RELATING TO KNOW OR UNKNOWN COMPLICATIONS WHICH MAY ARISE DURING OR FOLLOWING THE APPLICATION PROCESS INCLUDING, BUT NOT LIMITED TO, CLAIMS FOR NEGLIGENCE. I FURTHER RELEASE AND HOLD HARMLESS SELFIE BY SK FROM ANY CLAIMS RELATING TO PREEXISTING CONDITIONS I HAVE NOT REVEALED OR CHANGES TO THOSE CONDITIONS SUBSEQUENT TO THE PROCEDURE.

    I AGREE THAT ANY DISPUTES BETWEEN SELFIE BY SK, SHALL BE SETTLED BY ARBITRATION ADMINISTERED BY THE AMERICAN ARBITRATION ASSOCIATION IN ACCORDANCE WITH ITS COMMERCIAL ARBITRATION RULES, AND JUDGEMENT ON THE AWARD RENDERED BY THE ARBITRATOR(S) MAY BE ENTERED IN ANY COURT HAVING JURISDICTION THEREOF THE PREVAILING.

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