What to ask
Pregnancy/breastfeeding; cold-sore history; current medications (especially blood thinners, isotretinoin, immunosuppressants, steroids); diabetes and how controlled; autoimmune, bleeding, heart or thyroid conditions; keloid/hypertrophic scarring; allergies (pigments, metals, latex, adhesives, lidocaine/'caines', nickel); skin conditions active on or near the lips; recent sunburn; recent lip filler, surgery, laser or peels; previous permanent makeup and any reaction to it; recent illness or vaccination.
How to use it
Do not just file the form — read it with the client, ask follow-ups, and decide: proceed, proceed with a modification (antivirals, longer intervals, different anaesthetic), defer, or refer for GP/specialist clearance. Note your reasoning.
Records
Keep the signed form with the consent, colour/pigment/batch record, before photos and aftercare acknowledgement. Many jurisdictions require client records be retained for a set number of years and produced on inspection.