2020 Hill Visit Feedback Form

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.

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* 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.

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

Senator/Representative

Staff member(s)

Name of person(s) you meet with

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

First time visiting

Constituent

Personal friend or relative

Financial donor

Acquaintance

Campaign adviser or volunteer

Other (please specify)

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* 4. Issues discussed at the meeting?

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

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

Yes