PA Family Physician of the Year Nomination Form
Make your nomination today by completing all of the fields on this form. Please be sure to review the list of eligibility requirements for candidates below:
- Must be a family physician
- Provides his/her patients with compassionate, comprehensive and caring family medicine on a continuing basis
- Is directly and effectively involved in community affairs and activities that enhance the quality of his/her community
- Provides a credible role model professionally and personally to his/her community, to other health professionals, and residents and medical students
- Can effectively represent the specialty of family practice and the AAFP in public speaking
- Is in good standing in his/her medical community
- Is a member of the American Academy of Family Physicians/PA Academy of Family Physicians
Practice Address:
(street address required)
(city required)
(zip code required)
YOUR INFORMATION:
We need information about you to process and confirm your submission. We will never share this information with outside parties, and we will contact you only about this nomination.
Address:
(street address required)
(city required)
(zip code required)
How did you hear about this award:
Tell us why this physician should be PA Family Physician of the Year. Provide as much information as possible below:
(required)
