ISN-GKHA 2027 – People Living with Kidney Disease Contact Form

  • ISN-GKHA 2027 – People Living with Kidney Disease Contact Form

  • The International Society of Nephrology (ISN) is preparing for the fourth iteration of the Global Kidney Health Atlas (ISN-GKHA). As part of this initiative, we aim to better understand the lived experiences of people with chronic kidney disease regarding access to and quality of care.

    This form is intended to collect contact details of individuals living with chronic kidney disease who may be invited to complete a questionnaire.

    The information you provide will be used only for the purpose of contacting the individual to share the questionnaire and related outputs (e.g., summary report, paper for publication).

  • Section 1: Respondent Information

  • Are you filling this form for yourself or on behalf of someone else?*

  • Section 2: People Living with Chronic Kidney Disease Information

  • Patient Type*

  • Section 3: Personal Details

  • Section 4: Recruitment Information

    Recruitment Source (Recommended by individual or via organization/initiative)

  • Section 5: Consent and Data Use

  • Please read and confirm:

    • I understand that the information provided will be used solely for the purpose of contacting the individual to complete the 2027 ISN-GKHA lived experiences of people with chronic kidney disease questionnaire.
    • I understand that the responses collected will be used to produce a summary report and potentially a paper for publication, which will be shared with participants.
    • I understand that no personal data will be used beyond this purpose.
    • I confirm that, if I am providing another individual’s details, I have obtained their permission to share this information for this purpose.
    • I consent to ISN contacting the individual using the provided details to share the questionnaire and related outputs.
  • Should be Empty: