The American Diabetes Association needs your feedback to ensure we are providing the right information in the right way.
You can take the survey now, if you're ready, or take it later after you've spent more time on the site.
Thank you in advance for your help!
No, thank you.
Become a Member
Become a Member
Learn more about the Health Care Professionals Legal Advocacy Network at http://www.diabetes.org/patientrights
Your Professional Website (or LinkedIn):
1. Which of the following credentials do you currently hold? Select all that apply.
CDE — Certified Diabetes Educator
DO — Doctor of Osteopathy
MD — Doctor of Medicine
MSW — Social Worker
RN — Registered Nurse
NP — Nurse Practitioner
PA — Physician’s Assistant
PhD — Doctorate
PharmD/RPH — Registered Pharmacist/Doctor of Pharmacy
RD — Registered Dietitian Other (specify):
2. Please state your specialty, if applicable:
3. Please select all states in which you are willing to help:
4. In which areas are you interested in helping? Select all that apply.
EmploymentEducationDaycare/ChildcareCorrectional FacilitiesPolice MisconductPublic AccommodationsDriver's LicensesOther
5. How would you like to help? Select all that apply.
Assisting with the development of diabetes-related educational materialsEducating individuals about their rights (e.g. presentations, lectures)Making phone calls (e.g. calling employers, schools, etc.)Writing letters (e.g. requesting school/work accommodations, etc.)Training school personnel in diabetes care management in school settingsTraining police departments on appropriately responding to individuals with diabetesTraining jails and prisons on diabetes care management in correctional settingsTraining other health care professionals on diabetes discrimination issuesConsulting with attorneys on legal cases (i.e. giving advice, analyzing health-related claims, explaining medical conditions)Being an expert witness at trialsSupporting the Association’s legislative effortsHelping to recruit new members of the HCP Legal Advocacy Network
6. How have you have been involved with the American Diabetes Association? Select all that apply, if applicable.
Joined the Stop Diabetes movementSubscribed to Diabetes Forecast magazineSubscribed to a professional member publicationSubscribed to e-newslettersDonated moneyVolunteered (in a Non-Advocacy Attorney Network capacity)Attended a Diabetes EXPOPurchased books, materials, or videos from the American Diabetes Association’s online storeParticipated in Step Out: Walk to Stop Diabetes eventParticipated in a Tour de Cure eventChild attended a Diabetes CampParticipated in an online message boardParticipated (or child participated) in School Walk for Diabetes eventAttended the Scientific Sessions ConferenceOther (specify below):
7. Check the box below —
8. If you want to recommend a colleague for us to contact for recruitment into the HCP Network or the Advocacy Attorney Network, please list their name(s), email address(es), and professional title(s).
I am ready to help
I have questions and would like to speak to a staff member before I help
By completing this form, you are signing up to participate in the ADA Health Care Professionals Legal Advocacy Network. There is no fee to participate and no annual requirement for volunteering.
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