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Would you like to speak to someone who has made the adjustment to living with kidney disease?

Your Medical Team will help you understand the facts about the diagnosis and treatment options. However, it may be helpful to speak with someone who has already “walked in your shoes,” either as a patient or as a caregiver

The Kidney Foundation of Central Pennsylvania (KFCP)

has trained and certified volunteer patients, many from your own doctor’s practice – called Certified Partners who have experienced kidney failure themselves or who have been part of the support team for a loved one with kidney failure.

How Can You Meet a Certified Partner?

Tell a member of your Medical Team – your physician, physician’s assistant, nurse, or social worker – that you are interested in meeting with a Kidney Foundation Certified Partner. After you sign a brief consent form to participate in the program and complete an information sheet to help the Certified Partner learn a little bit about you, a member of your Medical Team will send your information to KFCP. KFCP, in turn, will match you with a Certified Partner who will contact you by phone. If you wish to meet with the Certified Partner personally, you can arrange a suitable meeting place – either the clinic, your home, a restaurant, or wherever you think will be most comfortable. We think it’s a phone call you’ll be glad you received!

For More Information :

If you or your Medical Team would like more information about the KFCP Patient and Family Partner Program, call the Program Coordinator at 1-800-762-6202 or email: info@kfcp.org

The Kidney Foundation of Central Pennsylvania
900 S. Arlington Avenue Suite 134A
Harrisburg PA 17109

Mentee Information Form

Personal Information
Contact Information
Medical Information
Current Treatment (Check one)
Do you use (check all that apply)
Additional Information

Mentee Consent Form

I would like to participate in The Kidney Foundation of Central Pennsylvania’s Patient and Family Partner Program. As a condition of my participation, I give permission for the following:

  1. I give my permission for the KFCP to release my name and the information I have provided to a Certified Partner who will contact me regarding participation in the program. The KFCP will not release or use my name and contact information for any additional purpose without my express permission

  2. I give my permission for my physician (___________________________________) to release a brief medical summary regarding my kidney disease to the KFCP so that a Certified Partner can be assigned. My Medical information will not be released by the KFCP or used for any other purpose without written consent.

  3. I give my permission for the KFCP to release my name and the information I have provided to a Certified Partner who will contact me regarding participation in the program. The KFCP will not release or use my name and contact information for any additional purpose without my express permission

  4. I give my permission for the KFCP to release my name and the information I have provided to a Certified Partner who will contact me regarding participation in the program. The KFCP will not release or use my name and contact information for any additional purpose without my express permission

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