Fields marked with an Asterisk* are mandatory
When preparing your answer please consider the following:
What qualities do you feel make your GP special, please highlight any outstanding contributions or commitments the GP had made to your care.
How have they made a difference to your life? Please give examples of how they have impacted on your quality of life and action(s) taken that you feel are above and beyond the call of duty.
In no more than 500 words please tell us:
RCGP Northern Ireland may reproduce an anonymous version of your nomination for promotional purposes.
Patients will not be identifiable in the text used.
Please enter your name below if you consent to information provided in this form, or photographs taken at the RCGP Northern Ireland GP of the Year Award event
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