GP of the Year Award 2018 Nominated Form

 

Nomination form
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Contact Details for your GP
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Are you a patient of this GP?


Reason for nomination

What qualities do you feel make your GP special, please highlight any outstanding contributions or commitments the GP had made to your care.

How has she or he 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:

Important Information: Prior to every patient nomination being judged by the lay members of the RCGP Wales Patient Group they are anonymised. Nominations are judged on the content of each nomination and not purely based on the number of nominations received per GP.
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Please complete the section below
GPs who are nominated may want to see their nomination. Do you want your GP to see your nomination?



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For your information

RCGP Wales may wish to reproduce an anonymous version of your nomination in print for promotion or learning purposes. Patients will not be identifiable in the text used.

Do you agree to this?


Consent and declaration
Please tick this box if you consent to information provided in this form, or photographs taken at the RCGP Wales Gala Awards evening on Friday 15th November 2019, being used for publicity purposes by the College.
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Please complete the consent and declaration

Please enter your name below if you consent to information provided in this form, or photographs taken at the RCGP Wales Gala Awards evening 15th November 2019 being used for publicity purposes by the College

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