Nomination Form

This online nomination form is the official entry form for the 2014 Million HeartsĀ® Hypertension Control Challenge.

You will be asked to register and create an account to save your progress in case you wish to complete the nomination form over more than one session.

We ask that you provide very specific information about the nominee practice, patient population and the tools and techniques used to treat hypertension. You can download and print a copy of the nomination form to help gather the information you will need in order to successfully complete and submit the nomination form. If you have any questions you can click the contact link in the footer.

Please answer each question as fully and accurately as possible. Your nomination is complete when you agree to the assurances by typing your name in the box provided and hit the "Submit Nomination" button at the end of the form. You will be able to print a copy of your completed nomination form.

Nominations that are emailed or scanned will not be accepted.