Patient Partner Sign-Up Form

All fields below are mandatory unless otherwise indicated.

*Province/Territory
*Gender
Are you a member of any of the following groups?
*How did you hear about the Can-SOLVE CKD Network?
*Briefly describe your experience with kidney disease
*List your skills and / or special interests
By signing up, you will receive regular updates on volunteer opportunities. You will also receive Can-SOLVE CKD's monthly newsletter, from which you will be able to unsubscribe at any time.

If you're having issues completing this questionnaire, please call 604.806.9376 or email info@cansolveckd.ca.  

The Can-SOLVE CKD Network will collect personal information under section 26 (c) of the Freedom of Information and Protection of Privacy Act for the purposes of operating the Can-SOLVE CKD Network. Personal Information submitted by volunteers will be saved and stored on file by the Can-SOLVE CKD Network upon submission. If you have any questions about the collection of your personal information, please get in touch with us by phone or e-mail.

Adapted with permission from the Patient Voices Network supported by the BC Patient Safety & Quality Council.