Complete the brief questionnaire below to submit your nomination for the Physician of the Year.

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* 1. Name of Doctor

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* 2. Type of Doctor (i.e., family practice, general surgeon, etc.)

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* 3. Your Name:

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* 4. Your Email Address or Phone Number (In case we have additional questions)

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* 5. Why do you feel this doctor should be awarded Faith Regional's Physician of the Year?

Nominations will be accepted through November 1 for the 2021 Physician of the Year.  

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