Do you have to give tattoo aftercare instructions in writing? 38 states say yes.

The tattoo is done, the wrap is on, and the client walks out with a sheet of paper. In 38 states that sheet is the rule, not a courtesy, and in 15 of them the client signs to say they got it. Here is what all 50 states and the District of Columbia say about aftercare instructions for a tattoo, in one table, each row read from the state's own rule and linked to it.

39 states require aftercare instructions. 38 say in writing. Kentucky, the 39th, lets you choose written, spoken or electronic. 23 say out loud and in writing, both. 6 put the instructions in the client's hands before the work starts: California, Kentucky, Michigan, Mississippi, Montana and Oklahoma, and Philadelphia adds itself locally. 15 make the client sign for it, on the tattoo consent form or on the sheet itself. 3 make you post a copy in the shop as well: Arkansas, Tennessee and West Virginia. 11 have no state rule, and Nebraska's version of no rule is pamphlets posted where clients can read them. Delaware's rule, in the sections read for its page, says nothing either way.

No row here carries a *. The state files grade their confidence on the record, the minors rule and the consent form, not on this section, so where a rule is thin the cell says so in words: New York's rule is New York City's, and Massachusetts's is the model rule each board of health adopts. Each state name links to its page on this site, which carries the whole rule.

This is a plain-language summary, not legal advice. Your local health department has the final word. Ask them, and bring your records.

What the sheet has to say

Most rules say aftercare instructions and stop. 21 go on to say something about what the sheet has to cover, and they agree more than you would expect. 4 things come up again and again: how to care for the site, the signs of infection, when to see a doctor, and the shop's name and phone number.

New Jersey's sheet covers care of the site, possible side effects, restrictions, the signs of infection and when to see a physician, N.J. Admin. Code 8:27. New Mexico's says how to clean it and when to see a doctor, with the list spelled out, unexpected redness, swelling, rash, drainage, or a fever within 24 hours, plus the shop's address and phone, 16.36.5.11 NMAC. Nevada's names the shop and the artist, says how to care for the site, lists the side effects, says when to see a physician, and gives the expected healing time, NAC 444.00809. New Hampshire gets practical: bandaging, skin care, what to wear while it heals, sun and water, skin products, and when to seek treatment, Plc 606.04. Minnesota wants the sheet to spell out the difference between normal irritation and an infection, Minn. Stat. § 146B.07. Utah and Georgia put the health department's own name, address and phone on it next to yours.

South Dakota is the one rule that writes the sheet for you. S.D. Admin. R. 44:12:01:32 says the artist "shall provide written instructions regarding the proper care and precautions for a new or newly removed tattoo to each patron" and then lists them: remove the bandage after 24 hours, wash gently with mild soap and water and pat dry, apply an antibacterial ointment at least twice daily, keep it out of direct sunlight for 2 weeks, no swimming or soaking until healed, no scratching or picking, and if redness or swelling develops, contact your doctor. If you have ever wondered what a state thinks a good aftercare sheet says, that is it.

7 states hand you the words or approve yours. Alabama's rule prints the sheet in Appendix D and makes it the minimum, Ala. Admin. Code r. 420-3-23-.05(2). Alaska adopted the board's March 2003 Educational Information and Aftercare Instructions by reference as the minimum, 12 AAC 09.940. Arkansas's instructions are Department-approved. Georgia's are approved by the county board of health. Massachusetts's are approved by the local board of health. Michigan's are the department's own documents, and a shop's version has to be at least as comprehensive. North Dakota's are department-approved too, and New York City publishes sample wording.

Most of these rules cover piercing in the same sentence. Texas says the area tattooed or pierced, Wisconsin says the tattoo or pierce. Where a state's piercing rule is separate, the state's page says so.

Sign for it

15 rules want proof the client got the sheet, and the proof is a signature. Texas has the client sign the record saying they read and understand the instructions, 25 TAC § 229.408. New Jersey keeps a copy of the written instructions, signed by the client, with the record. Alaska and North Dakota have both of you sign and date the sheet. Maine keeps a signed copy in the file. Colorado, Massachusetts, Mississippi, Montana, New Mexico, Oregon, Utah and Virginia put the acknowledgment on the consent form itself. California and South Carolina go one further and print the instructions in the form the client signs. South Carolina's rule says the notice "shall be signed by the client", S.C. Code Regs. 60-111.

That is why the aftercare sheet and the consent form travel together in the rules. The form says what the client understood before the work, the acknowledgment says what they were handed after it, and the inspector reads them as one record. What the form itself has to say, state by state, and how long the record has to stay in the file, are the rest of that record.

Before or after

The rules disagree on when. Most say when the work is finished: Wisconsin after completing a procedure, Tennessee after each tattooing, the District of Columbia upon completion. 6 say before. Michigan's documents go to the client before the procedure starts. Mississippi's printed statement goes out prior to the tattooing procedure beginning, Rule 11.5.11. Montana's goes before every procedure, ARM 37.112.133. Oklahoma's before starting the procedure, 310:233-3-7.1. Kentucky's rule reads "before the application of a tattoo, the client shall be provided written, verbal, or electronic aftercare instructions", 902 KAR 45:065 § 8. California's are printed in the consent form the client reads, completes and signs "prior to the performance of body art", Cal. Health & Safety Code § 119303(a). Philadelphia says before too.

The before rules treat the aftercare as part of the consent: a client who has read that the site stays out of the pool for 2 weeks is agreeing to that as well as to the needle.

Where there is no rule

11 states have no aftercare rule for a tattoo: Arizona, Connecticut, Hawaii, Idaho, Indiana, Missouri, Nebraska, North Carolina, Pennsylvania, Washington and Wyoming. 3 of those are local-rule states in disguise. Philadelphia requires written and verbal instructions before the work. Natrona County in Wyoming wants a signed statement that the client got them. Connecticut leaves it to the towns. Nebraska wants the pamphlets on the wall. Delaware makes 12 where the state says nothing.

Hand the sheet over anyway, in all 12. A client who calls a week later about redness is holding your number because the sheet put it there. In 38 states the rule is a piece of paper. What it buys you in all 51 is the same thing: the client's own copy of what you told them, and your record of having said it.