Welcome to the BREEZE TRANSPLANTTM online health history questionnaire.
Please answer all questions truthfully, accurately, and completely, as the information you provide
here will be used by our Transplant Team to detect any medical conditions that may affect your ability to donate a kidney.
This questionnaire is considered extremely confidential. Only health professionals on the Transplant Team will use
this information. This information will not be shared with the recipient or others. It is confidential.
This survey will take approximately 15-20 minutes to complete. You must complete the survey
in a single session, and we recommend you use a desktop or laptop computer for best results.