Registration For Patients/Caregiver/Family members – VoKAL – National Kidney Foundation

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About VoKAL
Agenda
Area of focus
Kidney Alliances

Registration

Patients/Caregiver/Family members
Healthcare Personnel
Industry player
Public

Join our inspiring alliance
Raise your voice

Raise your voices

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MY

EN
MY

Registration
for Patients/Caregiver/
Family members

Thank you for joining VoKAL

(Voice-out Kidney Alliances).

You will be the pioneer of this alliance. As a member of VoKAL, you will be kept up-to-date on the latest VoKAL news, activities and much more!

What is Your title?
MrMrsMs

What is your name?

What is your age?

What is your address?

City

Postcode

State

What is your mobile number?

What is your email?

What is your current job position? Registration category?
PatientOrgan donorFamily member/caregiver Current Status? Received kidneyDonated kidneyCurrently on continuous ambulatory peritoneal dialysis – CAPDCurrently on automated peritoneal dialysis - APDCurrently on haemodialysis - HDDiagnose with chronic kidney disease but still has not start dialysisNone of the above If you are currently diagnosed with chronic kidney disease (CKD), please state which stage are you
Stage – 1Stage – 2Stage – 3Stage – 4Stage – 5UnsureNot Applicable if you are currently on dialysis, which dialysis provider did you go?
GovernmentPrivateNGOHome dialysis Dialysis centre Preferred Language
MalayEnglishChinese

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About VoKAL

Kidney Alliances

Patients/Caregiver/Family members
Healthcare Personnel
Industry player
Public/ Vokal Ambassador

Become an alliance

Raise your voice

Agenda
Area of focus

CONTACT INFO

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