Data Collection Form

The data collected will be used to assist the Barbados Kidney Association in achieving our mission of generating accurate and useful information on Kidney Disease within the Barbados. Information shared or programmes developed, would assist patients in need by delivering programs that educate, build awareness and drive advocacy; resulting in greater public understanding of Kidney Disease and ultimately the prevention of Kidney Disease in Barbados.The information you share will allow us to provide support to patients on a more personal level so we can better respond to any requests, understand needs, and provide information and required resources. Only SILS clinic will have access to your name.

Survey

PERSONAL DETAILS


EMPLOYMENT HISTORY


MEDICAL HISTORY


GENERAL