If your Healer's Touch Sculpture or DAISY Honoree pin has been lost or damaged, you may request a replacement below. Please note that there is a $60.00 shipping and handling fee for a replacement sculpture and a $5 donation request for a replacement pins.

Type of Replacement Item Needed

Type of Replacement Needed:

Honoree pins are for nurses who received The DAISY Award (this includes the sculpture, Honoree pin, gift bag, and celebration). The nominee pin is for any nurse who was nominated for the DAISY Award and should have received the pin and a copy of the nomination.

Honoree Pin: Nominee Pin:

Honoree/Nominee Details

Name of Honoree/Nominee:

Name of the facility where you received or were nominated for The DAISY Award:

Do you still work at that facility?

Name of your current facility:

Registration Information

Are you a registered Honoree with The DAISY Foundation? If you are registered, select yes and paste your spotlight link in below. To find out if you are registered and to copy your link, please visit www.DAISYFoundation.org and use the magnifying glass at the top right corner to search for your name.

Link to your online DAISY Spotlight: (Copy and Paste from DAISYFoundation.org) Example: https://www.daisyfoundation.org/daisy-award/honorees/Jane-Doe

Please upload a picture of your Healer's Touch Sculpture and.

Shipping Information

Shipping to Business or Residence?

First Name:

Last Name:

Phone:

Email:

Street Address:

Apt/Unit:

City:

State:

Postal Code:

Invoicing Information

We know accidents happen and sometimes a Healer's Touch Sculpture needs to be replaced. While we don't charge for the sculpture itself, we do ask that you cover the cost of shipping and handling for a total of $60.00. After you submit the form below, we will email you an invoice within a few business days, and once we receive payment, we will ship you a beautiful replacement sculpture.

First Name For Invoice:

Last Name For Invoice:

Email for Invoice:

Amount:

Invoicing Information

We know accidents happen and sometimes a Healer's Touch Sculpture needs to be replaced. While we don't charge for the sculpture itself, we do ask that you cover the cost of shipping and handling for a total of $60.00. After you submit the form below, we will email you an invoice within a few business days and once we receive payment, we will ship you a beautiful replacement sculpture.

First Name For Invoice:

Last Name For Invoice:

Email for Invoice:

Amount:

You will be sent an invoice for your Healer's Touch Sculpture. Below you will see information about an additional $5 donation you can place separately, to cover the cost of your pin, if you wish.

Donation Request

The DAISY Foundation is a non-profit organization committed to keeping costs low for our partners. If you are able, we hope that you will consider donating $5 to us to offset the cost of your replacement pin and shipping. Donations are handled through PayPal and go directly to support the mission of The DAISY Foundation.

The link to donate will appear after you hit submit below.

Acknowledgment

By checking this box and submitting the online form, you agree to The DAISY Foundation collecting and storing your personal contact information. We may contact you if we have questions about your submission or to discuss next steps. To learn more, please read our Privacy Policy.

I Agree

Contact Information