Share Your Story

Would you like to share your personal story with kidney disease? Other people can benefit greatly from hearing about your experience. Please complete this form and someone will contact you shortly.

The fields followed by an asterisk (*) indicate information that must be supplied to allow us to process your request.

Your personal information will be shared with the appropriate Kidney Foundation staff member for the sole purpose of contacting you to obtain additional details about your story and discuss possible use in Kidney Foundation marketing and awareness initiatives.

*This question is required.

I consent to the collection, use, and disclosure of my personal information.

First Name *This question is required.

Last Name *This question is required.

City *This question is required.

Phone Number (including the area code): *This question is required.

Email Address *This question is required. This question requires a valid email address.

Submit your story: *This question is required.

Upload your photo(s):
Allowed types: png, gif, jpg, jpeg, doc, xls, docx, xlsx, pdf, txt, mov, mp3, mp4
Max file size: 500 KB

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Have you ever used any programs or services provided by The Kidney Foundation? *This question is required.

If yes, how have they enriched your life?

Have you ever volunteered for The Kidney Foundation? *This question is required.

Why do you feel the work of The Kidney Foundation is important?

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