KDAE Initiatives: Scheduled Visit Information

1. KDAE Initiatives - Scheduled Visit Information

ANNA wants to know what Senator or Representative will be visiting your unit and when. Please help us keep track of KDAE Initiative visits! ANNA Federal Health Policy Associates will follow up with the Congressional office with any additional information and reinforce the message(s) you delivered.

Thank you!

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* 1. Personal Information:

Name:

City/State:

Phone:

E-mail:

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* 2. KDAE Initiative Visit Information

Dialysis Unit:

Elected Official Visiting:

Date Scheduled:

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* 1. Personal Information:

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* 2. KDAE Initiative Visit Information

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* 3. Please list any questions or comments concerning the upcoming Scheduled visit.