Before We Begin

Please confirm your eligibility to complete this screening.

Are you 18 years of age or older? *
Are you currently residing in Canada? *

Visit History

Help us understand how many times you've used this resource.

Part 1 of 3: Contact Information

Required fields are marked with *. Optional fields may be left blank or marked "Prefer not to share."

Letters, spaces, hyphens, and apostrophes only (e.g., Mary-Jane, O'Brien)
Letters, spaces, hyphens, and apostrophes only (e.g., Singh-Patel, MacDonald)
Sex *
Used only to send appointment reminders if you opt in, and to fulfil data-removal requests.
Format: (###) ###-#### — digits are auto-formatted as you type
Format: A1A 1A1 — letter, digit, letter, space, digit, letter, digit (auto-formatted)

Part 2 of 3: Background Information

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Certain ethnicities have higher risk for kidney disease. This helps us provide relevant guidance.
Do you currently have a family doctor? *
Have you seen any of these specialists in the last 2 years? (Select all that apply, optional)

Part 3 of 3: Medical History

Required fields are marked with *. Please answer each question; if you are unsure, select "Don't know".

Have you been told by a doctor that you have diabetes? *
Have you been told by a doctor that you have high blood pressure (hypertension)? *
Have you been told by a doctor that you have heart disease (of any type)? *
What is your smoking status? *
How would you describe your alcohol consumption? *
Has your mother, father, or a sibling ever been told they have kidney disease? *
Do you know the result and date of your most recent eGFR (kidney function) test? *
Do you know the result and date of your most recent ACR (urine albumin) test? *