Lifestyle Change Award Nomination
Sponsored by: Molina Complete Care
Your Name
First Name
Last Name
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example@example.com
Nominee's Name
First Name
Last Name
Picture of Nominee
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What type of lifestyle change has this person accomplished?
Increased Physical Activity
Adopted Healthier Eating Habits/Weight Loss Plan
Stopped Smoking or Vaping
Managed Blood Pressure, Cholesterol or Blood Sugar
Learned Family's Heart/Brain Health History and Risk Factors
Other
Please describe why this person deserves recognition for their lifestyle change:
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