2021 Houston Health Heroes / Nomination Form
Doctors for Change (DFC) would like to recognize and celebrate individuals who as a direct provider of health are dedicated to providing extraordinary services to the Houston community. Those eligible will include physicians, nurses, therapists, counselors, social workers or other health-related professionals providing direct services in the Greater Houston area. Anyone (physicians, staff, faculty, students or general public) may nominate a member for this award. Award recipients will be announced at the DFC 15th Anniversary Reception and Celebration on November 6, 2021. There is no limit on the number of individuals you may nominate. Please submit a separate from for each nominee. Please contact us if you have any questions regarding the nomination form and/or reception.

Jorge Cruz (he/him)
Program Manager
jorge@doctorsforchange.org
Doctors for Change
www.doctorsforchange.org
Sign in to Google to save your progress. Learn more
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Doctors for Change. Report Abuse