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Positive patient feedback
Has someone made a real difference to your care?
This is your chance to say thank you to the member of staff or team
Name of individual you wish to nominate
Individuals job title (if known)
Nominee's manager (if known)
Nominee’s manager’s email address (if known)
Department/ward
Hospital site
Charing Cross Hospital
Hammersmith Hospital
Queen Charlottes Chelsea Hospital
St Marys Hospital
Western Eye Hospital
Reason for nomination
Please provide as much information as possible, including examples to demonstrate how your nominee has made a difference
About you
I am
A patient
A visitor
A member of staff
Other
Your name
Job title (Trust staff only)
Telephone number
Email address
Please confirm your email
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