Our use of cookies

We use necessary cookies to make our site work. We'd also like to set optional analytics cookies to help us improve it. We won't set optional cookies unless you enable them. Using this tool will set a cookie on your device to remember your preferences.

For more detailed information about the cookies we use, see our Cookies page

Necessary cookies

Necessary cookies enable core functionality such as security, network management, and accessibility. You may disable these by changing your browser settings, but this may affect how the website functions.

Analytics cookies

We'd like to set Google Analytics cookies to help us to improve our website by collecting and reporting information on how you use it. The cookies collect information in a way that does not directly identify anyone. For more information on how these cookies work, please see our Cookies page .

Please note the page will reload to apply your settings.

Patient network celebration event - nomination form

We believe success should be celebrated.

We also believe that you know someone that demonstrates what it means to succeed; to surpass expectations and to go above and beyond what is asked of them. That is why we're hosting a brief awards ceremony as part of this year's Patient network celebration event; to showcase and give praise to those individuals who take something good, and make it amazing.

Below is a short form that gives you the opportunity to nominate that certain someone to get the recognition they deserve.

All nominees will be recognised and we politely ask that all nominations are submitted to us by 20th May 2016.

Thank you, and we look forward to seeing you on 1st June!

Name of nominee*


Criteria (please select one)*

Brief Description of work:*

Email 2*:

* required fields