Nomination form

To have your nomination considered please ensure that you fully complete this form. We recommend you review the questions asked below first and then make a draft answer in a word document which can then be copied and pasted into the text boxes.

Contact details for nomination
First Name
Last Name
Address Line 1
Address Line 2
Address Line 3
Post code
Phone number
Email address
Practice/Clinic name
How long has this associate been working at this practice?
When did the associate register as an osteopath?
From which institution did they graduate?
Are they an iO member? (if known)
About the associate
For each of the below questions please provide a short summary.
We have provided indicative questions of the types of activities that you may want to share. These are indicative only. You may wish to provide other information that is relevant to the nomination.
1. Tell us how the associate has contributed to exceptional patient care?
Your answer (maximum 500 words)
Examples of additional/innovative services
How they have provided additional or innovative services to support your patients?
Do they actively engage with your patient base on a regular basis?
Do they proactively seek to develop their clinical new skills and apply best and evidence-informed practice?
Do they help build the evidence for osteopathic practice through the use of patient feedback, clinical audit or similar tools such as PROMs?
2. Tell us how the associate has collaborated with the clinic team/and/or their local community?
Your answer (maximum 500 words)
Examples of how they may have collaborated
How they have behaved as a member of the clinic team?
Have they shown exemplary support to their colleagues?
Do they engage with other osteopaths/osteopathic groups in your area?
Have they supported any collaborations with local businesses, charity or other healthcare professionals in your area?
3. Tell us how the associate has contributed to the successful running of an osteopathic business?
Your answer (maximum 500 words)
Examples of how to evidence they have contributed
Have they developed or applied business skills that have contributed to the practice?
Have they proactively supported the promotion and marketing activities of the practice's services?
4. Are there any other activities that you wish to share that demonstrate the values or approach of the associate that you wish the judges to consider?
Your answer (maximum 500 words)
Any examples of outstanding behaviour, innovation or initiatives that you wish the judges to consider.
Your contact details
If different from above
First Name
Last Name
Email address
iO membership number (if relevant)
Phone number
Your relationship to the associate

If you have any questions or experience any difficulties with the form please contact the Communications team via email at

How this data will be used:

  1. The information provided will be for exclusive use by the Institute of Osteopathy (iO) 
  2. Any information provided may be used by the iO in its print and online publicity materials for this award.
  3. The iO will not share the data submitted with any third parties.
  4. The iO will hold this data securely.
  5. For more details of the iO's privacy policy click here.