Kidney Care Bermuda

Patient Treatment Tool

Question Title

* 1. I have daytime responsibilities (such as work, school or family) that make it difficult for me to go to a dialysis center three times a week for treatment.

Yes

No

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* 2. Having a flexible diet is important to me.

Yes

No

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* 3. I want to take fewer medications that treat high blood pressure and other heart-related issues, if possible.

Yes

No

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* 4. I want to be able to travel without having to go to a dialysis center during my trip.

Yes

No

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* 5. I would prefer to dialyze at night so that my days are free.

Yes

No

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* 6. I have someone (a spouse, family member, friend, etc.) who can assist me with my dialysis if I choose to do treatments in the comfort of my own home, instead of a center.

Yes

No

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* 7. I am afraid of needles.

Yes

No

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* 8. I would enjoy having the chance to socialize with other dialysis patients while getting my treatment.

Yes

No

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* 9. Swimming and/or taking baths are part of my usual routine.

Yes

No

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* 10. I would prefer to receive dialysis treatment at an outpatient dialysis center.

Yes

No

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* 11. I would prefer to have a skilled dialysis care team provide my treatment.

Yes

No

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* 12. Contact Information

Name

Email Address

Phone Number