Bloom Awards Nomination Form

Please follow the simple instructions listed below:

Provide us with ALL the contact information of the nominee for the category you chose.
Please add ALL nominee/nominator information in order to contact you and the nominee.
Please read ALL category sections carefully as some categories are referring to a practice/company ONLY, NOT an individual.
Please add your nominee into the correct category or it will NOT be counted.

Please press "submit" at the end of the form. Once you do, a confirmation of

your nomination will be sent to us automatically via email.

History of the Excellence Awards Gala

The Excellence Awards were created in 2011 by BLOOM as a platform on which to recognize the best-of-the-best performance of professionals working within the workers’ compensation industry through a nomination process resulting in a formal and beautiful Awards Gala. Over the past decade, through a formal nomination and selection process, awards have been given to professionals for their outstanding commitment, care, and service.

Excellence Awards Mission

The Excellence Awards recognize industry leaders who exemplify excellence and truly embody

a commitment to leadership, mentoring and professional practice.

Please read award categories first before submitting your nomination(s)!

Read Award Categories

Don't forget to join BLOOM today to receive updates about the BLOOM Awards!

Join Bloom Today

NOTE: The following categories are ONLY for nominating Service Providers!

Rehabilitation Specialty Provider Award
Superior Urgent Care and Occupational Medicine Award
Service Provider Of The Year Award

NOTE: The following category is ONLY for nominating podcast shows!

Podcast Of The Year Award

NOTE: The following category is ONLY for nominating TPAs!

TPA Of The Year Award

Nominee Contact Information:

If you're submitting a nomination for a company (service provider) rather than an individual, please enter "N/A" in both the first and last name boxes.

Nominee's First Name

Nominee's Last Name

If you're nominating an individual, and not a company (service provider), TPA, or podcast please enter "N/A" in the practice/company nominee box.

Company (Service Provider), TPA, or Podcast Nominee

Nominee's Email

Nominee's Phone

Nominee's Company

Nominee's Title

I confirm that I read the category information & this individual (or company/podcast) is in the correct category

Why do you nominate this person (or company) for this category?

Nominator Contact Information:

Nominator's First name

Nominator's Last name

Nominator's Email

Nominator's Company

Thanks for submitting! We have received your nomination!