U.S. House NIH Letter Feedback Form
The purpose of this form is to track which representatives were contacted, and what their responses were to our patient advocates and allies.
What is your name?
What is your email address?
In which state do you reside?
What is your zip code (plus four). If you are unsure, click here:
In which Congressional district do you reside?
What is the name of your U.S. House representative?
When did you make the initial contact with your representative's office?
What was the name of the staff member with whom you spoke? (if applicable)
What is the position of the individual with whom you spoke? (if applicable)
What is the email address/contact information for the staff member (if applicable)?
How did you contact this office?
How often did you contact this office?
Did the office agree to sign the letter?
Maybe (in the works)
I have not received an answer yet
I did not receive any response
What was the office's general response? Was it positive? Negative?
Is there anything else we should know about this particular representative and your interaction with the office?
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