CAREGIVER OR FAMILY MEMBER

Submit this form if you are or were a caregiver or close family member of someone with kidney disease. Please give as much information as you are comfortable with.

Read other caregiver - family member stories

Name

First Name

Last Name

Email Address

Location

The city and state where you live.

What is YOUR story?

Tell us how you identify yourself as an individual and what your life is all about. We want to get to know YOU. Anything about your career, hobbies, passions, family etc that you are comfortable sharing and would help us know you.

Who in your life has kidney disease/failure? What was the cause?

Please explain when the diagnosis of kidney disease/failure was and any details that would help us understand the situation.

What is your role? What sort of things do you do to help the patient/family member?

Please give as much detail as you can and are comfortable with so we fully understand your situation.

How has your life changed?

Mention any life adjustments that had to be made. Please don't feel guilty about being honest. It's important to share this side of the story so others know how to support care givers in the future.

Where do YOU get support from?

Mention any online resources or organizations if applicable.

How do you get through the really difficult days?

What do you feel others can do to support you?

Any advice you'd like to give other caregivers of kidney patients?

Anything else you'd like to add.

Any social media accounts we can tag to help promote awareness on Facebook, Instagram, Twitter.

In not just say NO.

Do we have permission to share your story on our social media and blog?

Yes

Would you be willing to email us a picture of yourself for the blog?

If YES, please email photo(s) to info@getloudforkidneys.org

Yes

Would you like to be signed up for the Get Loud For Kidneys Newsletter?

Get notifications about new kidney blog posts, kidney stories and upcoming events and advocacy. Minimal emails. You can unsubscribe at any time.

Yes