Tri-State Daisy Award Nomination
Your Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
I am...
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A Patient
A Family/Visitor
A Registered Nurse
A Physician
Tri-State Memorial Hospital Staff
A Volunteer
Name of the nurse you are nominating:
*
Department they are in:
*
Share your story of why your nurse should be honored for the compassion and care they provide their patients everyday, please provide as much detail as possible:
*
Tri-State Marketing & Communications may contact me regarding my DAISY Award testimonial.
Yes
No
I would like to be added to Tri-State Memorial Hospital's email list to receive messages regarding hospital changes, updates, service lines, provider information, or general marketing communications.
Yes
No
Submit
Should be Empty: