Client Pre Screening Questionnaire

Absolute Preclusion Questions

Yes

 No

01)

If you are, or think you might be pregnant, or if you are currently breast feeding; then you should wait until after you have given birth and finished breast feeding before undergoing any cosmetic tattooing. 

02)

If you have any condition that predisposes you to overgrowth of scar tissue then having any form cosmetic tattooing may trigger the scar overgrowth condition. If you are unsure if you have this condition then seek advice from your doctor. 

03)

Have you taken a medication containing Isotretinoin (e.g. Roaccutane) during the previous 12 months?

If you have taken medication containing Isotretinoin at any time during the previous 12 months you may be predisposed to hypertrophic (overgrowth) scarring. You should wait until at least 12 months after ceasing the medication and then discuss with your doctor before considering any Cosmetic Tattooing.

04)

Have you been using any experimental, unapproved, or illegal medications or skin treatments? (e.g. RU 58841)

If you ceased using an experimental treatment longer than 3 months ago then you should discuss it with your doctor and cosmetic tattooist, and if in the opinion of your doctor the experimental treatment would not adversely interact with your intended cosmetic tattooing then a test patch should be performed and reviewed prior to having a full Cosmetic Tattoo treatment.

Medical Advice / Contraindication Questions

Yes

 No

05)

Do you have, or do you think it is possible you may have a Blood Borne Communicable Disease?
e.g. Hepatitis C Virus (HBC), Hepatitis B Virus (HBC), Human Immunodeficiency Virus (HIV)

In some countries a persons communicable disease status may be protected under legislation, however in most circumstances having a Blood Borne Communicable Disease (BBCD) would be a contraindication for cosmetic tattooing.

If you have tested positive or if you believe it is possible you may have a BBCD then you may be at greater risk of developing a serious skin infection after tattooing. You should discuss your current health status and intended tattooing with your doctor and the cosmetic tattooist. Additional precautions, equipment, and facilities may be required which your intended cosmetic tattooist may or may not be able to accommodate. It should be borne in mind that a cosmetic tattoo is non essential and purely cosmetic in nature.

06)

Do you currently have any symptoms of any other form of communicable disease, or any known infection?
e.g. COVID-19, any respiratory infection, gastrointestinal infection, skin infection, ear or eye infection, bacterial, fungal or viral infection etc.

If you have any symptoms of COVID-19 you should check with your cosmetic tattoo technician what testing, waiting period, and restrictions may apply prior to having a cosmetic tattoo treatment, additional Personal Protective Equipment may also be required at the time of your appointment.

For most other infections you should wait until at least 2 weeks after complete healing, or if you have had a skin infection you should wait at least 4 weeks after your infection has completely healed before undergoing cosmetic tattooing.

If you have had an antibiotic resistant infection of any kind you should seek advice from your doctor and the cosmetic tattooist before undergoing cosmetic tattooing, additional precautions with hygiene and aftercare may be required.

07)

Do you have Diabetes, currently on any form of immunosuppressant therapy, or have any other condition that may cause delayed healing?

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

If in the opinion of your doctor cosmetic tattooing does not pose an unnecessary risk to your health then additional precautions with hygiene and aftercare may still be required.

08)

Have you ever had a Herpes Simplex Type I infection (also called cold sores/fever blisters)?

You should seek advice from your pharmacist and your cosmetic tattooist before undergoing cosmetic tattooing, prophylactic treatment may be advisable particularly prior to and after lip tattooing.

If you have ever had a severe outbreak of cold sores then you should discuss with your doctor/pharmacist the possibility of a stand by prescription for an oral antiviral medicine which could be taken at the first sign of an outbreak.

09)

Do you have any Hypersensitivity, Auto-Immune Disorder, or Allergic Conditions?

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

If in the opinion of your doctor cosmetic tattooing does not pose an unnecessary risk to your health then a pigment test patch should be performed and reviewed prior to having a full Cosmetic Tattoo treatment.

NB. If you have any severe allergies that have ever resulted in; asthmatic attack, anaphylaxis, or hospitalization, then a pigment test patch should only be performed with direct medical supervision.

10)

Do you have a known allergy or sensitivity to any topical or local anaesthetics including dental anaesthetics?

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

If a topical anaesthetic is to be used during your cosmetic tattoo procedure you will need to ensure that it does not contain ingredients that you are known to be sensitive/allergic to. Also caution is advised with the use of any topical anaesthetics unless you are confident that you are not allergic to the ingredients.

11)

Do you have a known personal or family history of methemoglobinemia?

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

Extreme caution: a topical anaesthetic should not be used during your cosmetic tattoo procedure unless your doctor is in agreement and there is direct medical supervision.

12)

Have you ever taken a medication containing Bisphosphonate/Diphosphonate? (e.g. fosamax, alendronate)

This medication is sometimes prescribed to treat conditions such as osteoporosis, Paget's disease or bone cancer.

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

Non essential invasive procedures of the mouth are contraindicated whilst taking this medication due to the risk of osteonecrosis of the jaw (ONJ), lip tattooing should be avoided.

There may also be a risk of adverse pigment colour changes therefore a pigment test patch should be performed and reviewed prior to any cosmetic tattoo procedure.

13)

Do you have any form of bleeding disorder, or are you taking any anticoagulants (blood thinners)?

Anticoagulants include medications such as warfarin, heparin, salicylates (aspirin) and some anti-inflammatories (ibuprofen).

In normal health and with low doses most supplements should not cause excessive bleeding but high doses (mega) of some supplements may interfere with normal blood clotting particularly; Omega 3 fatty Acids (Fish Oil/Flaxseed Oil), Vitamin E, Vitamin C, Coenzyme Q-10, Ginseng, Ginkgo Biloba, Garlic, Saw Palmetto and Glucosamine.

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

Depending on your health status and only if your doctor is in agreement then ceasing non essential anticoagulant medications/supplements several days prior to and after cosmetic tattooing may help prevent excessive bleeding.

If in the opinion of your doctor your medications, supplements and medical conditions do not preclude you from having cosmetic tattooing then extra precautions would still be required during and after the treatment to help prevent excessive bruising and the associated risk of pigment migration.

14)

Have you had any form of Cosmetic or Surgical Procedure, Radiotherapy, or Chemotherapy at any time during the past 6 months? And Or
Have you ever had breast implant or joint replacement surgery?

This includes but is not limited to things such as cosmetic or reconstructive surgery, cancer treatments, dermal fillers, botox injections, laser treatments, and any form of skin resurfacing.

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

Depending on the type of procedure or treatment you had and the location on your body there may be a waiting period required before having cosmetic tattooing and or your surgeon may suggest a short course of prophylactic antibiotics prior to/after cosmetic tattooing.

15)

Do you suffer from any form of hyper-pigmentary skin condition?

These are conditions that may result in increased pigmentation of the skin after minor skin trauma and include conditions such as Melasma, Post Inflammatory Hyper-Pigmentation (PIH), and inflammatory skin conditions with associated hyper-pigmentation. If you have scars or blemishes where the surrounding skin has become darker in colour this may indicate the presence of a hyper-pigmentary skin condition. If in doubt answer yes to this question.

If you are unsure whether you have a hyper-pigmentary condition you should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

People with hyper-pigmentary skin disorders should not undergo cosmetic tattooing because the tattooed area or the surrounding skin may become darkened (Black, Brown, Blue, Grey discolouration) due to an over production of melanin in the skin.

There may be an exception to this if the intention is to re-pigment an area of skin that has hypo-pigmentation (loss of natural pigment) in which case a test patch should be performed and reviewed prior to having a full Cosmetic Tattoo treatment.

16)

Have you ever taken a medication containing Isotretinoin (e.g. Roaccutane)

Answer yes to this question even if it was more than 12 months ago.

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

People who have taken this medication may be predisposed to hypertrophic (overgrowth) scarring even if you took this medication many years ago. If in the opinion of your doctor your past medications and medical conditions do not preclude you from having cosmetic tattooing then then a test patch should be performed and reviewed prior to having a full Cosmetic Tattoo treatment.

17)

Do you suffer with fainting, blackouts, or seizures?

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

If your condition is unstable, or if you are inclined to have an episode when you experience discomfort or stress, then cosmetic tattooing may not be possible.

If in the opinion of your doctor your medical conditions do not preclude you from having cosmetic tattooing then additional precautions may still be required and some treatments may or may not be possible for safety reasons (e.g. eyeliner).

18)

Do you have a cardiac pacemaker, Implanted Cardioverter Defibrillator (ICD), have a serious heart condition, or abnormal blood pressure?

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

If your condition is unstable, or if you are likely to have an adverse cardiac/blood pressure event when you experience discomfort or stress, then you should not undergo cosmetic tattooing.

Also, if you have a pacemaker or ICD and you are considering cosmetic tattooing particularly over the chest region (e.g. nipple tattooing) then you should seek advice from your cardiologist about the "theoretical risk" of micro-shock during skin penetration with an electrical cosmetic tattoo device.

19)

Are you currently suffering from an emotional upset, major depression or other psychiatric illness?

Answer yes to this question if you feel that currently your judgment may be impaired for any reason.

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

If you are currently depressed, experiencing emotional problems, if your psychiatric illness is unstable, or if you feel that your judgement may be impaired then you should not consider making semi/permanent changes to your appearance without discussing it and seeking guidance from your health advisor and significant others (friends and family).

20)

Do you have any form of acute or chronic eye condition?

You should seek advice from your eye specialist and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

If in the opinion of your eye specialist your eye condition does not preclude you from having cosmetic tattooing then additional precautions may still be required and modifications to technique may be necessary. For example if you have Glaucoma it is important not to apply any pressure to the eye or surrounding structures.

21)

Have you had breast reconstructive surgery in the previous 12 months, or are you due to have breast reconstructive surgery at a future time?

You should seek advice from your surgeon and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

It is advisable to wait 6-12 months after completion of any reconstructive breast surgery before having Areola tattooing to ensure that the reconstruction has completely healed, all swelling has subsided and the final size, shape, and orientation of the breast has been reached, prior to placement of the areola complex tattoo.

22)

Do you have an autoimmune, inflammatory, fibrosing, scarring, cyclical, temporary or transient form of alopecia?

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

If you have one of these forms of alopecia scalp tattooing may be inappropriate, contraindicated or may potentially exacerbate (worsen) some types of alopecia. A medical tattooist who has undergone specialised training in scalp tattooing should be able to discuss the alopecia diagnosed by your doctor and inform you if scalp tattooing is contraindicated for your condition.

23)

Do you have a hypo-pigmentary disorder? (e.g. Vitiligo)

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

You should explore all available treatment options with your doctor prior to considering cosmetic tattooing, after that if you intend on having cosmetic tattooing to re-pigment affected skin areas it is advisable to wait until your condition has been stable for at least 12 months.

24)

Are you prone to developing Telangiectasia? (sometimes referred to as spider veins) 

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

If you easily develop telangiectasia's then traditional skin needling, Meso-Therapy, Multitrepannic Collagen Actuation (MCA), Collagen Induction Therapy (CIT), Dermal Rollers etc are contraindicated as they may exacerbate (worsen) your condition.

Contemporary forms of shallow depth low impact sub-epidermal treatments e.g. MESO-Vytal may be suitable if the technician has undergone specialised training.

25)

Do you suffer with any other major health problems or medical conditions or are you taking any other regular Medications?

You should seek advice from your doctor and discuss with the cosmetic tattooist before undergoing cosmetic tattooing.

If you have a major health problem and or if you are taking regular medications and you have any doubt if it may be relevant to the decision to undergo cosmetic tattooing then you should always seek advice from your doctor.

26)

Are you less than 18 years of age?

Laws differ from country to country and state to state, in many locations there are laws that prevent tattooing those under a certain age, some countries may permit tattooing of a minor if there is a written request from a medical practitioner due to a medical reason and if there is parental consent. If in doubt check with your doctor, cosmetic tattooist and local authorities.

Special Precautions Questions

Yes

 No

27)

Have you or any member of your household suffered with any form of skin infection in the previous 12 months?

If so there is an increased risk of having reservoirs of antibiotic resistant bacteria within your home.
You should seek advice from your cosmetic tattooist, additional precautions with hygiene and aftercare may be required.

28)

You should discuss this with your cosmetic tattooist who will need to provide the cosmetic tattoo treatment with latex/rubber free supplies (e.g. gloves and machine covers).

29)

Do you have a known allergy or sensitivity to any ingredients within tattoo pigments or needles, regular makeup, any preservatives, hair dyes, or other dyes?

e.g. glycerine, isopropyl alcohol, ethanol alcohol, iron oxides, titanium oxide, other metal oxides, nickel, witch hazel etc

You should discuss this with your cosmetic tattooist a pigment test patch with a pigment/needle that does not contain substances that you are known to be sensitive to should be performed and reviewed prior to having a full Cosmetic Tattoo treatment.

NB. If you have any severe allergies that have ever resulted in; asthmatic attack, anaphylaxis, or hospitalization, then a pigment test patch should only be performed with direct medical supervision.

30)

Do you have a known allergy or sensitivity to any ingredients in tattoo aftercare creams, antiseptics, lanoline, or petrolatum (petroleum jelly)?

You should discuss this with your cosmetic tattooist an aftercare cream that does not contain ingredients that you are known to be sensitive to will need to be chosen.

31)

Do you wear contact lenses?

You should not wear contact lenses during the treatment and for at least 48 hours after eyeliner tattooing.
Small particles of pigment may accidentally splash into the eye during an eyeliner treatment and if pigment becomes trapped under your contact lenses it could result in a corneal abrasion.

32)

Are you currently using any scalp lotions to treat androgenic alopecia?

e.g. Minoxidil, Avacor Physician's Formulation, Mintop, Amexidil, Rogaine, Spectral.DNC, Vanarex, Kopexil.

You should discuss this with your cosmetic tattooist, scalp tattooing is contraindicated whilst using these types of topical medications, a medical tattooist who has undergone specialised training in scalp tattooing should be able to discuss this with you and inform you if scalp tattooing is contraindicated whilst using specific lotions and treatments.

33)

Have you used any eyelash or eyebrow growth serums / creams or any eye drops that may contain prostaglandin analogues in the past 4 weeks?

e.g. Latisse, LILash, Bimatoprost/Latanoprost Drops etc, information can be read on this link.

You should discuss this with your cosmetic tattooist, a withholding period may be required before and after tattooing. If you are using medication prescribed by your doctor you should not cease using the medication unless advised to do so by your treating doctors.

Comments

Disclaimer, Terms & Conditions: This questionnaire should only be regarded as a general guide & is not intended to replace medical advice or pre treatment health screening by a cosmetic tattooist, always consult with your medical practitioner before acting on any information in relation to any medical condition or health related circumstance. This form is provided 'as is' without any guarantees, warranties, or liability of any kind, use entirely your own risk. Your use of this form is strictly on the basis of your acceptance of the above terms and conditions.