Patient and Care Partner Story Collection

Patient and Care Partner Story Collection
Are you interested in impacting your community to make a difference? Take action! Use your voice to shine a light on kidney disease.

Are you currently on dialysis? Or have you received a successful transplant, but used to be on dialysis? Newly diagnosed with chronic kidney disease or a living kidney donor? We'd love to hear your story and hear about your kidney journey.

Please fill out this quick interest form, and we will be in touch to follow up with you!
Full Name*

PrefixFirst NameLast NameSuffix
Contact Phone Number*
Please enter a valid phone number where you can be reached.
Email Address*
example@example.com
Your connection to kidney disease*
Current treatment*
Where do you live?*

CityState

Zip Code

What is generally a good time to call you to learn more about your story? Please select all timeslot(s) M-F that are best for you.*

Please note here anything specific about your availability that you'd like us to know.

Demographics