TriState Health DAISY Award Nomination
***You can now nominate a NURSE or a TEAM FOR THIS AWARD***
Your Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
I am...
*
A Patient
A Family/Visitor
A Registered Nurse
A Physician
TriState Health Staff
A Volunteer
Other
Are you nominating a NURSE or a TEAM?
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Nurse
Team
Name of the NURSE or TEAM you are nominating:
*
Department they are in:
*
Share your story of why your NURSE or TEAM should be honored for the compassion and care they provide their patients everyday, please provide as much detail as possible:
*
TriState Marketing & Communications may contact me regarding my DAISY Award testimonial.
Yes
No
TriState Marketing & Communications can share my story internally and externally.
Yes
No
If yes, can they include your name?
Yes
No
I would like to be added to TriState Health's email list to receive messages regarding hospital changes, updates, service lines, provider information, or general marketing communications.
Yes
No
Submit
Should be Empty: