Patient Survey

The mission of The NephCure Foundation is to support research seeking the causes and cures for the serious kidney conditions Nephrotic Syndrome (NS) and Focal Segmental Glomerulosclerosis (FSGS). We also offer many services to educate patients and their families about these diseases and new advances in research including new treatments. We need you to be counted in the NephCure family. By providing the information below you enlarge our community and motivate researchers to focus on these conditions. We can make more noise in our efforts to raise awareness if we have accurate numbers of all those affected and the greatest progress will be made when all patients have been counted. Please take a moment to complete this survey.

First name: *

Last name: *

Address

Street address: *

City: *

State: *

Country: *

Zip code: *

Home Phone: *

Cell Phone:

Email:

What is the name of the patient?: *

Patient Gender: *