Welcome to the BREEZE TRANSPLANTTM online health history questionnaire.
Thank you for your interest in becoming a living kidney donor. We are committed to looking after your
health and safety throughout the donation process.
You can start the process by filling out the form below and answering the subsequent basic questions
about whom you wish to donate to and your state of health. Submission of the form does not imply any
commitment or obligation on your part. You can stop the process at any time.
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.