If you are suffering from kidney disease, please fill out this assessment form to have your case assessed.
We will review your case and will get back to you within 24 hours
| You may also download the assessment from by clicking this link Assessment Form
|*If you are sending your reports as an attachment in a seperate email, please keep your total attachment size less than 1MB. Scanning reports in black and white mode may reduce the file size considerably. Thank you for your understanding. Reports can be sent to email@example.com|
If you do not receive a reply within 24hrs, please check your junk mail folder and feel free to send us a reminder.