American Diabetes Association: Survey - Congress at Home 2019: Meeting Feedback

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Congress at Home 2019: Meeting Feedback

THANK YOU for participating in the ADA's Congress at Home 2019. Please fill out this short form to let ADA know about how each of your meetings went and allow staff to know what follow up is needed. Submit one form PER meeting.

Enter Your Information

Name:

First Required	Last Required

E-mail: Required

Street 1:

City/State/ZIP:

City	State	ZIP

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Yes, I would like to receive postal mail from American Diabetes Association

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*2.

Question - Required - Which congressional meeting are you submitting this feedback report for? (Enter first and last name of the member of Congress)

*3.

Question - Required - Did you meet with the senator/ representative?

*4.

Question - Required - Did you meet with staff?

	Yes
	No

Question - Not Required - Staff Name (first &last)

*6.

Question - Required - Does the legislator support our ask to provide $185 million the National Diabetes Prevention Program ( National DPP)?

Oppose

Likely Oppose

Neutral

Likely Support

Support

*7.

Question - Required - Does the legislator support our ask to provide $185 million for the CDC's Division of Diabetes Translation?

Oppose

Likely Oppose

Neutral

Likely Support

Support

*8.

Question - Required - Does the legislator support renewing the Special Diabetes Program (SDP)?

Oppose

Likely Oppose

Neutral

Likely Support

Support

*9.

Question - Required - Does the legislator support making insulin affordable?

Oppose

Likely Oppose

Neutral

Likely Support

Support

10.

Question - Not Required - Did the office request any follow-up? If so, please describe:

11.

Question - Not Required - Did the member of Congress or their staff mention a personal connection to diabetes?

12.

Question - Not Required - Do you have any additional comments or a story to share about your meeting with this office?

Spam Control Text: Please leave this field empty

American Diabetes Association
2451 Crystal Drive, Suite 900
Arlington, VA 22202 1-800-DIABETES (800-342-2383)