AAKP HealthLine Webinar Registration: Keeping Your Dialysis Access Site Healthy Survey

1.Please complete the following: (Required.)

First Name

Last Name

Email Address

2.Mailing Address

Street Address or P.O. Box

Apt., Suite, Building, etc.

3.City(Required.)

4.State/Province(Required.)

5.Zip Code / Postal Code(Required.)

6.Country

7.Phone Number

8.Do you have any questions or comments for the webinar speakers?

9.Are you a:

CKD patient (not on dialysis)

In-center hemodialysis patient

Home hemodialysis patient

Peritoneal dialysis patient

Kidney transplant recipient

Living kidney donor

Family member/care partner

Health care professional (e.g., physician, social worker, nurse, dialysis technician, etc.)

Other - please comment

Thank you for registering for the upcoming AAKP HealthLine webinar. You will receive an email from AAKP within 24 hours of the scheduled webinar with details on how to join.

AAKP thanks Medtronic for providing an educational donation to support this program.

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