2023 Hill Visit Feedback Form Survey

Share your feedback with us following your meetings with members of Congress. This information is valuable in providing follow-up communication to congressional offices and maximizes our advocacy efforts on behalf of physicians.

1.Please tell us about yourself:

Name:

Address:

City/Town:

State:

ZIP/Postal Code:

Email Address:

Phone Number:

Please tell us about the FIRST office you visited. You will have the opportunity to tell us about your other hill/district visits on subsequent pages.

2.Who did you meet with? (check all that apply)

Senator/Representative

Staff member(s)

Name of person(s) you meet with

3.Your relationship with this individual? (check all that apply)

Other (please specify)

4.Issues discussed at the meeting?

5.Additional comments about this hill visit? Please include any follow up that is needed from AMA Staff.

6.Do you have another hill visit or district visit to tell us about?

Yes

No