The Befriending Service, which is available to all Kidney Patients and their families, provides support for those patients waiting to go onto dialysis, are already on some form of dialysis, are on the transplant waiting list or has recently received a transplant. At any of these stages in the treatment of end stage renal failure (ESRF) concerns and worries can occur. Sharing these concerns and worries with a patient or carer who has had first hand experience of these, and who is willing and trained to help, may well alleviate many of these concerns.

Please fill in this form and click on "submit" at the bottom of the document if you would like to be considered as a "befriender"

NAME : Mr. Mrs. Miss Ms.

ADDRESS

TELEPHONE No.

POST CODE :

Email :

I AM A : TRANSPLANT PATIENT DIALYSIS PATIENT CARER PRE DIALYSIS

AGE : 18 - 30 31 - 40 41 - 50 51 - 60 61 - 70 Over 70 years

YOUR UNIT :

Thank you for your support.

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