The Patient's Choice Award 2024: Nomination form

This popular award aims to recognise individuals or groups whose commitment and dedication have ensured that exceptional care is delivered to our patients.

Name of the team/person you are nominating *

Ward/Department/Hospital *

Why are you nominating this team/person? Please give as much information as possible. *

What is your name? *

Your telephone number

Your Email Address *

My submission may be used for publicity purposes. Do you agree? *

If yes, would you be willing to use your name, or would you like it anonymised? *

Yes
No (I would like to remain anonymous)

Are you willing to be contacted for publicity purposes if your nominee is shortlisted? *

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The Patient's Choice Award 2024: Nomination form