Anesthesiologist of the Year Nomination

Do you know or work with an outstanding Anesthesiologist? Nominate him/her below for Somnia’s sixth annual Anesthesiologist of the Year Award! This year’s award recipient will receive an Amazon Echo.

Deadline for submissions is midnight, Friday, April 13, 2018. The winner will be announced on Wednesday, April 18 2018.

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* 1. Your Name

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* 2. Your Email Address

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* 3. Your Phone Number

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* 4. Your Employer & Job Title

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* 5. May we let the nominee know you nominated him/her?

Yes

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* 6. Nominee's Name

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* 7. Name of facility at which nominee practices

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* 8. Nominee's Email Address

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* 9. Nominee's Phone Number

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* 10. Do you work with the nominee?

Yes

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* 11. If you answered yes, for how long you have worked with the nominee?

Less than 3 years

4-6 years

7-9 years

10+ years

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* 12. What qualities, characteristics, or work style do you believe make this nominee an outstanding anesthesiologist? How does s/he exemplify high quality anesthesia care?

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* 1. Your Name

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* 2. Your Email Address

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* 3. Your Phone Number

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* 4. Your Employer & Job Title

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* 5. May we let the nominee know you nominated him/her?

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* 6. Nominee's Name

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* 7. Name of facility at which nominee practices

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* 8. Nominee's Email Address

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* 9. Nominee's Phone Number

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* 10. Do you work with the nominee?

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* 11. If you answered yes, for how long you have worked with the nominee?

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* 12. What qualities, characteristics, or work style do you believe make this nominee an outstanding anesthesiologist? How does s/he exemplify high quality anesthesia care?

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* 13. Please add any additional comments.