Tattoo history worksheet

Tattoo Removal Consultation Worksheet: Goals, History and Questions

Prepare for a tattoo-removal consultation in Lancaster with a copyable record of your goal, tattoo history, prior work and unanswered questions.

PublishedOctober 2026Consultation planning guide

Use this guide to organize questions for a consultation. It does not recommend a treatment or provide personal medical advice.

Make one record for each tattoo

If you are preparing for a tattoo-removal consultation in Lancaster, copy the fields below into a private note or onto paper. Use a separate record for each tattoo so dates, additions and earlier appointments do not get mixed together. This worksheet organizes what you know and what you still need to ask; it does not choose a treatment or predict a result.

  • Tattoo label and location: ____
  • Date I last updated this record: ____
  • My main question for the consultation: ____
  • Photo or document labels I want to refer to: ____

KMHCS tattoo-removal service information →

Write your goal separately from a proposed plan

The American Society of Plastic Surgeons includes your goals among the topics to discuss at a tattoo-removal consultation. Describe the change you would like to discuss in your own words. You can be undecided. Wanting a tattoo removed, asking about a future cover-up and knowing which option is appropriate are separate things.

  • I want to discuss: removal / a possible cover-up / another goal / I am undecided.
  • The part of this tattoo I want to discuss is: ____
  • Any part I hope to keep is: ____
  • Before choosing a next step, I need to understand: ____

ASPS: Topics for a tattoo-removal consultation →

Build a timeline, including what you do not know

AAD consultation guidance includes tattoo age, colors and body location. Start with details you can describe, then separate a remembered date from a documented one. Add a row for each addition, reworking or cover-up. A photo date may help organize your notes without establishing when the tattoo was made. Leave ink ingredients or other technical details unknown if you do not have a record.

Copyable tattoo history record
EventDate and what I knowSource or missing detail
Original tattooDate: ____; exact / approximate / unknownMemory / receipt / photo / other: ____
Visible descriptionLocation and colors I can describe: ____Photo label, if used: ____
Addition or reworkingDate and area changed: ____What I cannot confirm: ____
Cover-up over earlier workDate and earlier design, if known: ____Earlier photo or artist record: ____
Another eventDate and description: ____Record to request or question to ask: ____

AAD: What a tattoo-removal consultation considers →

Give earlier removal visits their own entries

If you have had previous removal appointments, record them separately from tattooing or design changes. Use the wording in any records you already have. If you remember an appointment but cannot confirm the method or equipment, write that down as unknown instead of guessing. Bring questions about your observations to the clinician.

  • Visit date, or approximate period: ____
  • Provider or location, if known: ____
  • What the record says was done: ____; record label: ____
  • What I remember or observed, in my own words: ____
  • What I want the clinician to explain: ____
  • Record I still need to request, and from whom: ____

Separate design questions from clinical questions

For a possible cover-up, keep questions about the proposed artwork separate from questions about a medical procedure. The FDA advises discussing tattoo-removal expectations, benefits and risks with a healthcare professional. An artist's design idea does not answer those clinical questions. Record who answered each question and what remains open before treating a suggestion as an agreed plan.

Questions and the person to ask
QuestionPerson to askAnswer and date
What design would I like to discuss, and which part of the existing tattoo concerns me?Tattoo artist, if considering new artwork____
What options, limits, benefits and risks should I understand for this tattoo?Clinician evaluating the removal request____
What history or records are still needed before a recommendation?Clinician evaluating the removal request____
What must be clarified before discussing timing for any next step?Relevant clinician or artist; record each answer separately____

FDA: Discuss tattoo-removal options and expectations →

Example: keep a missing fact visible

This fictional entry shows how to use the record. It is not a patient story or a treatment recommendation: Tattoo A, outer arm. Original tattoo around 2018, based on memory. More color added later; date unknown. A photo saved in 2022 shows both versions together. Goal: ask about a possible cover-up. Open questions: Which design does the artist have in mind? What does the clinician need to assess before discussing removal options?

  • Known: which tattoo the note refers to and the date on the saved photo.
  • Approximate: the remembered year of the original tattoo.
  • Unknown: when the additional color was applied.
  • Next action: look for the artist's record; keep the date marked unknown until confirmed.

Carry unanswered questions into your follow-up note

After the conversation, add a dated entry instead of replacing your original history. Keep your own goal, the advice you received and any decision you made in separate fields. If two conversations leave you with different instructions, record the difference as a question to clarify. The worksheet is a personal note, not a medical record or approval to proceed.

  • Question discussed: ____
  • Person who answered, date and any written reference: ____
  • Answer in my notes: ____
  • Information still missing or wording I need clarified: ____
  • Next action, who will take it and when to check back: ____

Use the general checklist for the rest of your visit

Keep this record focused on the tattoo. Use the general consultation-preparation guide for broader appointment questions and the information you may need to bring. Keep personal health information out of public posts or reviews.

General consultation preparation → · KMHCS contact and directions →

Sources and Further Reading

Useful next pages if you want to compare options, prepare questions, or review the relevant KMHCS service before calling.

Related next step

When you're ready, use the service pages to compare options or reach out for a more specific conversation.

Clinic details

KMHCS is located in Lancaster and serves Palmdale and Antelope Valley patients.

Address
767 W Lancaster Blvd, Lancaster, CA 93534
Hours
Monday-Friday: 8:30am - 12:30pm, 1:30pm - 5:30pm

Need a clearer next step?

Review the clinic pages or contact the team if you'd like to talk through options in a calm, consultation-first way.