The DAISY PETAL Award nomination form

This Patient Care Technician’s clinical skill and especially her/his compassionate care exemplify the kind of Patient Care Technician that our patients, their families, and our staff recognize as an outstanding role model.

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2022-FW-Good Samaritan Hospital-DAISY PETAL-PI
The Patient Care Technician you are nominating*

Thank you for taking the time to nominate an extraordinary, compassionate Patient Care Technician for this award. Please tell us about yourself, so we can include you in the celebration of this award, if the Patient Care Technician you nominated is chosen.

Please tell us about yourself

Your name*

How do we reach you?