* 1. Please provide your name and contact details

* 2. If possible, can you provide the name of the digital service/system, assistive technology or device you would like to nominate?

* 3. Please give a brief description of the digital service/system, assistive technology or device you would like to nominate?

* 4. Who recommended the digital service/system or device? Or did you find it yourself?

* 5. Where do you use the digital service/system or device?
Please indicate all that are appropriate. If you are willing to do so it would also be helpful to know the names of any NHS or Social Care organisations and staff who have helped you to use it or who you use it with.

* 6. Please describe how the digital service/system or device helps you?

* 7. Why do you think it should win the award?

* 8. Has it helped you do anything you couldn’t do before?

* 9. How easy is it to use?

* 10. How can it be improved?

* 11. Is there anything else you would like to say to help your nominated digital service/system or device win?

* 13. Where did you hear about these awards?

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