NATIONWIDE Houston Study - KIDNEY TRANSPLANT October/November 2017

Introduction Section

Plaza Research Houston is conducting a study with individuals who have had Multiple Kidney Transplants. The study takes place October/November, 2017 online. If you qualify, and are chosen to participate, you will receive $300-400for your time.

Please answer the questions below. If you look like a match, we will contact you by telephone.

**Due to the large response to our surveys, we are only able to contact those that look like a match. Please continue to answer future studies, as you may be a match to those.

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* 1. Please provide us with the following information. We will be contacting you by telephone if you seem like a match.

Name: *

City/Town

State/Province

ZIP/Postal Code: *

Email Address: *

Phone Number: *

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* 2. Alternate Contact number

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* 3. What is your age?

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* 4. What is your gender?

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* 5. Have you, in the past, been diagnosed with kidney failure by a physician?

Yes