Do you have to ask health questions before a tattoo? 20 states say yes. Here are the questions.

Before the needle, do you have to ask the client about their health? In 20 states the rule says yes, and 17 of them tell you what to ask. The other 31 mostly ask nothing, and 10 of those still bar you from working on a client who is drunk or high. Here is what all 50 states and the District of Columbia say about health questions before a tattoo, in one table, each row read from the state's own rule and linked to it.

The 20 do it 4 ways. Oklahoma, Utah, Vermont and Nevada's Clark County put the questions inside the tattoo consent form itself. 7 want a form of its own: Alabama's written medical-information request, California's signed questionnaire, Georgia's client evaluation, Michigan's health questionnaire in the record, Minnesota's separate disclosure form, New Jersey's medical history form, and Maine's, whose contents the 2005 rule left blank. 7 make you ask and write down the answers: Colorado, Delaware, Illinois, North Dakota, Oregon, Ohio and South Carolina, and in Delaware and North Dakota the client signs a release saying you asked. Massachusetts and New Mexico turn it around: the artist tells the client which conditions raise the risk, out loud and in writing, and the client signs that none of them apply.

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. Louisiana's health history is written as a should, not a shall, so it reads as no. 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.

The questions the rules ask

17 of the 20 name the conditions. Counted across their rules, as read for the state pages:

• Diabetes: 16 of the 17
• An allergy, to latex, pigments, dyes, antibiotics or soaps: 15
• Hemophilia, or a bleeding or clotting disorder: 15
• Skin disease, or a condition at the site, such as lesions, herpes or psoriasis: 15
• Blood thinners: 14
• Epilepsy, seizures or fainting: 10
• Hepatitis, HIV, or another bloodborne or communicable disease: 9
• Pregnancy or nursing: 8
• A heart condition: 6
• When the client last ate: 5
• Medications, generally: 5
• Drugs or alcohol, asked as a question: 3
• Keloids: 2
• An immune disorder: 2

Those are floors. A rule that names more than its state page quotes is undercounted here.

So the questionnaire most of the country is describing is 5 questions long: diabetes, a bleeding disorder, skin disease at the site, allergies, blood thinners. The longer lists add epilepsy, pregnancy and a heart condition. North Dakota's is the longest written into a rule: diabetes, hemophilia, skin disease or sensitivities, pigment allergies, epilepsy or fainting, blood thinners, medications beyond routine antibiotics, allergy medicine and birth control, hepatitis, HIV, high blood pressure or heart disease, pregnancy, contagious disease, immune disorders, and serious physical or mental health problems, N.D. Admin. Code § 33-41-01-05. Utah's 11 questions include whether the client has eaten in the last 4 hours and taken a blood thinner or an NSAID in the last 24, R392-701-14. Vermont asks about the last 2 hours' food and mitral valve prolapse, Code Vt. R. 04-030-310.

When a yes stops the work

A yes is not a no. In Ohio, a client who reports a condition that could affect healing is not tattooed without documentation from a physician, Ohio Admin. Code 3701-9-04. South Carolina wants a physician's signed statement that the tattoo is not contraindicated before the work starts, S.C. Code Regs. 60-111. Minnesota lets the technician decline if a condition shows up, and makes the form say the technician will not work on a client who does not complete and sign it, Minn. Stat. § 146B.07. Massachusetts and New Mexico have the client sign that they have no disqualifying condition. Montana never asks a questionnaire and still wants a written physician referral before working on a client on blood thinners, with a bleeding condition, recent IV drug use, a sunburn, skin disease, an infection or a mole at the site, or a pigment or soap allergy, ARM 37.112. Philadelphia makes the operator advise a client in its named risk categories to see a physician first.

The 31 that ask nothing still screen

31 states have no health questionnaire, and most of them screen anyway, without a form. 10 bar working on a client who is drunk or high: Hawaii, Missouri, South Dakota, Tennessee, Texas, Wisconsin, New Hampshire for anyone who appears impaired, and Kentucky, West Virginia and Mississippi with a line on the form where the client says so themselves. 7 make you look at the skin before you start: Iowa, North Carolina, Rhode Island, South Dakota, Tennessee, Texas and Wisconsin refuse a site with a rash, a lesion, an infection or a wound, and North Carolina and Arkansas add jaundice, visible in one, a history of it in the other.

Kansas hands the client a written sheet on 14 conditions instead of asking about them, K.A.R. 69-15-15. Mississippi's consent form carries warnings for clients with diabetes, HIV, end-stage renal disease or a heart condition rather than questions, Rule 11.5.10. Montana and Nebraska skip the form and make the record carry any allergy or condition that could hamper healing, which means you asked.

What happens to the answers

The answers are health information about a person, and the rules treat them that way. They go in the client's record, they stay there as long as the record stays, and the inspector can ask to see that the question was asked. Utah's rule says why the questions are there: "to evaluate the client's condition for receiving body art without violating the client's medical privacy", R392-701-14. That is the right read of every list in the table. The questions exist so the artist knows what they are working with before the needle. They are not a mailing list.

20 states write the questions down. In all 51 the client is sitting in front of you, and the 5 questions most of the country agrees on take a minute to ask. Ask them, and write down the answers.