Key Awards Nomination

Nurse's First Name

Nurse's Last Name

Nurse's Department

Please share the story of how this nurse provided extraordinary, compassionate care and why you believe he/she should receive the DAISY Award.

Your First Name

Your Last Name

Your Email

Your Phone

I am (please check one):
Patient Family/Visitor

Please contact me if my nurse is chosen, so that I may attend the celebration.
Yes No

I authorize Bothwell Regional Health Center to use my name in recognition materials for this nurse.
Yes No