American Diabetes Association: Survey - Special Diabetes Program SDP Hill Day 2019 Meeting Report Form

1.

Enter Your Information

*

Name:

First Required	Last Required

*

E-mail: Required

Street 1:

City/State/ZIP:

City	State	ZIP

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

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

Keep me logged in. What's this?

*2.

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

*3.

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

*4.

Question - Required - Did you meet with staff?

	Yes
	No

5.

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

*6.

Question - Required - Does the legislator support renewing the SDP?

Oppose

Likely Oppose

Neutral

Likely Support

Support

*7.

Question - Required - Would the legislator support an increase in funding for the Special Diabetes Program?

Oppose

Likely Oppose

Neutral

Likely Support

Support

8.

Question - Not Required - FOR SENATE MEETING: Does the legislator support the HELP Committee's legislation that extends SDP (S. 192/S. 1895)? (Leave this blank for House meetings)

Oppose

Likely Oppose

Neutral

Likely Support

Support

9.

Question - Not Required - FOR HOUSE OF REPRESENTATIVES MEETING: Does the legislator support the Energy and Commerce Committee's legislation that renews SDP (H.R. 2328)? (Leave this blank for Senate meetings)

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?