Client Consent & Health Disclosure

Part One

Client Identification

Full Legal Name *

Preferred Name

Email Address *

Phone Number *

Date of Birth *

You must be at least 18 years of age. Government ID required at appointment.

Appointment Sanctuary * Highland Park Sanctuary (Los Angeles, CA) Okanogan Residency (Okanogan, WA)

Emergency Contact Name *

Emergency Contact Phone *

Photo of Government ID (Driver's License / State ID / Passport) *

Upload or take a photo of your physical photo ID. Automatically archived in Daisy's studio system for legal compliance (18+).

Part Two

Health & Medical History

To ensure your physical safety and optimal healing, please disclose any conditions that apply to you. All health disclosures are kept strictly confidential.

Part Three

Day-Of Readiness & Sobriety

Tattooing is a somatic, energetically demanding process. Please affirm your physical readiness:

Part Four

Terms & Legal Release

Please read and initial your understanding of each sacred agreement below:

Part Five

Client Attestation & Signature

By signing below, I certify that all information provided above is true and complete to the best of my knowledge. I am at least 18 years of age, mentally competent, and entering this sacred container freely.