Form — Kidney Connect

Share your story.

If you need a kidney, fill in the form below, and we’ll use the information to a create a press release to send to your local media market.

Name

First Name

Last Name

Do you have a microsite with the National Kidney Registry? If so, link it below.

If you do have a microsite with the National Kidney Registry, you do not need to repeat information on your microsite in the form below. We can use information from your microsite in this press release. If you do not have a microsite, consider making one: https://www.findakidney.org/microsites/

Tell us about yourself

Discuss your family, career, hobbies, interests, causes that you care about — anything that means a lot to you, or that you would want included in a story about your search for a kidney. 150-200 words is ideal.

When did you learn that you have kidney disease? What is your current state of health?

Your kidney can come from anywhere. Which places have you lived or have some other personal connection to? For each place, please describe your connection in detail.

Establishing a strong connection to each place is important to tell a compelling story to your local media market.

Please check the box below if you would be open to joining a call with Kidney Connect to discuss your story in more detail.

Yes, I'd be open to joining a call.