Moorfields' Stars is our annual award scheme, designed to celebrate the achievements of some of our excellent staff. The patient choice award welcomes nominations from patients (past and present), friends and family of patients, carers and foundation trust members for a team or individual who has delivered exemplary patient care over the past 12 months.

Your nominee(s) will have displayed behaviours and values that had a positive impact on your patient experience and demonstrated their commitment to going over and above to assist and support you.

* 1. Name of your nominated team or individual:

We ask for the following information in case we need to contact you for more information, but we won't publish it anywhere and nominees will not be told who has nominated them without your permission.

* 2. Nominated by (please include your full name):

* 3. Contact number:

* 4. Email address:

* 5. Are you:

* 6. If the team or individual you nominate is shortlisted, we may get in touch to ask you to appear in a short video interview. Do you consent to this?

* 7. Which of the following Moorfields' Way commitments does your nominee(s) demonstrate? (please tick all that apply)

* 8. Please describe how your nominated team or individual fits the criteria for the patient choice award:

Thank you for completing the nomination form. Don't forgot to submit your nomination below.

Encourage others to get involved by using #MoorfieldsStaff on Twitter and follow us on @Moorfields.