JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Translated Materials Request Form
Please complete the below request form its entirety to receive hard copy translated materials from NKF New England. Please allow 4-6 weeks for receipt of materials in hard copy form.
To request electronic materials, please email Desirae Vasquez at desirae.vasquez@kidney.org.
Thank you!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Materials Requested (Availability may vary):
*
Are You the 33%?
Choosing Dialysis
If You Need to Limit Sodium
If You Need to Limit Potassium
If You Need to Limit Phosphorus
Living Donation
Make Decisions to Keep Yourself and Your Kidneys Healthy
Transplant Education
Required
Languages Requested (Availability may vary):
*
Arabic
Cape Verdean Creole
English
French
Haitian Creole
Khmer
Portuguese
Simplified Chinese
Spanish
Required
Number of Copies Requested (Value between 25-300):
*
Your answer
Shipping Address (Must be in MA, RI, NH, VT or ME. Requests for pediatric patients may come from CT.) :
*
Your answer
Email Address (We will contact you if we have a questions or an issue with your request) :
*
Your answer
Submit
Page 1 of 1
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
Help and feedback
Contact form owner
Help Forms improve
Report