KEEP Healthy Registration Form
The National Kidney Foundation is bringing our community kidney health screening program, KEEP Healthy, to three Kansas locations this year. Get registered now!

--- Saturday, August 25, 2018 (last screening at 1:30 pm)
--- CRC Care Center at Avondale East
--- 455 SE Golf Park Blvd
--- Topeka, KS 66605

The next KEEP Healthy Kidney Screening will take place in Topeka, KS. Although pre-registration is not required, it is encouraged. By pre-registering you can skip much of the registration process on the day of the screening. Please provide some basic contact information. This information will not be shared with anyone. Everyone who pre-registers, will be entered to win a gift card upon completion of screening!

What to expect at the event: risk survey, blood pressure check, body mass index measurement (BMI), an opportunity to speak with a healthcare professional, free education materials, and for individuals at risk, an ACR urine test for albumin (a type of protein). Must be 17 years or older to participate. KEEP Healthy is a free program for participants.

General and Medical Volunteers Needed for this event. Visit www.kidney.org/KEEPvolunteerKS for more information.

First Name: *
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Last Name: *
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Street Address:
Please include apartment and/or suite number if applicable.
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City:
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State:
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Zip Code:
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Email Address: *
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Phone Number: *
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How did you hear about KEEP Healthy?
Please select all that apply.
Would you like to receive additional information from the National Kidney Foundation *
What is your preferred language? *
What time would you like to attend the screening? *
The screening will take approximately 20-30 minutes to complete.
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