Practice team of the year award 2018

Nomination form
Practice details
Are you a patient of this practice

Reason for nomination

When preparing your answer please consider the following:

What qualities do you think make the members of your Practice Team special? Please highlight any outstanding contributions or commitments the Practice Team has made to your care.

How have they worked together to make a difference to your life? Please give examples of how the Team has 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:

Please complete the section below
Practices who are nominated may want to see their nomination. Are you happy for your Practice to see your nomination?

For your information

RCGP Wales may reproduce an anonymous version of your nomination in print for promotional or learning purposes.

Patients will not be identifiable in the text used.

Do you agree to this?

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 [date to be confirmed] being used for publicity purposes by the College


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