LIVING WITH KIDNEY DISEASE

OR KIDNEY FAILURE

Submit this form if you are living with kidney disease or kidney failure, either on or off dialysis.

It is a place to share your story if you are NOT necessarily looking for a donor right now.

Please give as much information as you are comfortable with.

Read stories from others living with kidney disease

Name

First Name

Last Name

Email Address

Location

The city and state where you live.

Do we have permission to tag you in social media posts about your story in order to reach more people for awareness?

Yes

No

Social media account names we can tag you in.

Facebook, Instagram, Twitter, YouTube etc.

When were you first diagnosed with kidney disease? What was the cause?

How has kidney disease changed your life?

What are some obstacles you have overcome? What are some things you are proud of?

How do you maintain a positive outlook on life?

What do you want more people to know about kidney awareness, kidney disease and or dialysis?

If you have chosen NOT to receive a kidney transplant, can you explain why to help others understand?

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

Yes

No

Would you be able to email us a picture of yourself for the post?

This is required. Email to info@getloudforkidneys.org OR give us permission to choose something from your social media.

Yes

No

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 - I promise. You can unsubscribe at any time.

Yes

No

#GetLoudForKidneys

#AwarenessCreatesChange