Kansas Family Physician of the Year
This is the official nomination form for 2018 Kansas Family Physician of the Year. As an alternative to completing this form, you may write a letter and send via email or U.S. Mail detailing your reasons why your physician is deserving of the title: Kansas Family Physician of the Year.

Kansas Academy of Family Physicians
Attn: Marina Spexarth
7570 W 21st St N. Bldg 1026, #104
Wichita, KS 67205
Or
Send email to: mspexarth@kafponline.org

The deadline to submit nominations for the 2018 Kansas Family Physician of the Year is December 30, 2017. Previous recipients are ineligible. A listing of past recipients is at www.kafponline.org/members/awards/familyphysicianoftheyear/

Your contact information
Your Name *
Your answer
Your email *
Your answer
Your Phone Number
Your answer
Your Address
Your answer
Your City State Zip
Your answer
Your nominee
Name of the Family Physician you are nominating (Note the family physician must be a member of KAFP. Contact mspexarth@kafponline.org if you are unsure.)
Your answer
In what city/town does this family physician practice?
Your answer
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