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.


Practice details
Name of practice
Practice Principal
Are they an iO member?
Address Line 1
Address Line 2
Address Line 3
City
County
Post code
Email address
Phone number
How many osteopaths operate at the practice?
How many other therapists/healthcare practitioners work at this practice?
Do you have non-clinical staff? If yes, in what roles?
On average how many patients visit the practice per week?
About the practice
For each of the below questions please provide a short summary of your approach.
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 about your approach to providing exceptional patient care.
Your answer (maximum 500 words)
Examples of what to include in your answer
Do you measure patient satisfaction?
Do you actively engage with your patient base on a regular basis?
Do you have a means to share skills, best practices and evidence-informed knowledge with your practice team?
2. Tells us how you collaborate and engage with your local community.
Your answer (maximum 500 words)
Examples of what to include in your answer
Does the practice actively engage with community events and/or groups?
Does the practice reach out/work with local businesses, charity or other groups?
Does the practice work with other healthcare professionals in your area?
Does the practice and/or its practitioners collaborate with other osteopaths/osteopathic clinics in your area?
3. Tell us about your approach to running a successful business?
You answer (maximum 500 words)
Examples of what to include in your answer
How has the practice provided additional or innovative services to support your patients?
Has the practice introduced technology to support patient services, your business operations, and/or marketing and promotion?
How does the clinic support the clinic team/associates/practitioners in their development, through, for example, mentoring, CPD or other training (clinical or non-clinical)?
4. Are there any other activities that you wish to share that demonstrate the values, approach and/or success of your practice that you wish the judges to consider?
Your answer (maximum 500 words)
Your contact details
If different from above
Salutation
First Name
Last Name
Email address
Are you an iO member?
iO membership number (if applicable)
Phone number
Your relationship to the practice



If you have any questions or experience any difficulties with the form please contact the Communications team via email at comms@iOsteopathy.org

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.