KEEP Healthy Registration Form
The National Kidney Foundation has an upcoming KEEP Healthy Kidney Screenings. 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.

Friday, March 3, 2017 9:00am-2:15pm International Institute 3401 Arsenal St, St. Louis, MO 63118

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 18 years or older to participate. KEEP Healthy is a free program for participants.

First Name:
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Last Name:
Your answer
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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Cell Phone Number:
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How did you hear about KEEP Healthy?
Your answer
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. Please note the times of the screening you choose.
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