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* 1. What is the name of the member of staff or team you would like to nominate?

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* 2. Can you confirm - is it a team or an individual nomination?

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* 3. Which department do they work in?

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* 4. Give reasons why you have nominated them for this award. How have their actions made a real difference to you/your family?(up to 250 words)

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* 5. Give an example which makes them a deserving winner of the Patients' Choice Award (up to 300 words)

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* 6. What is your name?

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* 7. Please provide us with your email address and/or contact number

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* 8. Important – we need your consent

We would like to share your name and nomination with your nominee, as well as use it and details of your nomination across our channels to publicise the staff awards. Are happy for us to do this?

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* 9. How did you hear about Royal Surrey Stars nominations? Please tick all that apply.

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