2019 HOH Congressional Visit Follow up
Please complete this form one time for each office that you visit on Tuesday. You can designate one person in your group to be responsible for the survey's or split them up so that each person takes a certain number.
Email address *
Your Name *
Your answer
Name of Representative Office Visited *
(e.g. Senator Bernie Sanders, Representative Peter Welch). Please list 1 per line
Your answer
State of Representative *
(e.g. VT, NY, OH)
Your answer
Meeting attendees from visit *
Who from the Representative's office met with you? Give the name of the staffer and/or actual representative. I don't need the names of the HOH advocates here.
Your answer
Feedback from visit on asks presented *
What did they have to say about the ask. Share your brief notes here. If they requested follow up or feedback, add that here too.
Your answer
Did they mention any personal connection to Migraine or headache disorders? *
If they mentioned a connection to migraine or headache disorders, did they say who it was?
(e.g. a senator or rep's name, a staffer, a family member). Please capture this information so we can relate back to them.
Your answer
Any additional feedback or information you wish to provide?
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service