JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
For Network staff: Transplant Trailblazer feedback
This guide was developed to help Networks stand up or enhance a program in which patients on dialysis are matched with transplant recipients to help motivate dialysis patients towards transplant.
Your feedback is important to us. Please view the document and then answer these questions.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
I will promote this program in my Network to support peer-to-peer sharing to increase patient awareness of kidney transplant options
*
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly Disagree
I will encourage the dialysis facilities and transplant centers in my Network to promote this program
*
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly Disagree
How might we improve this guide?
*
Your answer
Please select your network
*
Choose
Network 1
Network 2
Network 3
Network 4
Network 5
Network 6
Network 7
Network 8
Network 9
Network 10
Network 11
Network 12
Network 13
Network 14
Network 15
Network 16
Network 17
Network 18
Optional: Please share your name and email if you are interested in being contacted for further feedback
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
