Assessment Form You may have your case assessed for free. Assessment Form *we reply all our emails within 24 hours. If you do not receive a response within 24 hours please do not hesitate to contact us at info@kundankidneycare.com Patient InformationName* Phone: Age: Email* GenderGenderMaleFemaleOtherCountry Lab InvestigationDate of Test DD slash MM slash YYYY Hemoglobin - HB Blood Urea Serum Creatinine - Cr Additional QuestionsYour daily liquid input? Your daily liquid output? Are you on dialysis?NoYesRecommendedWhat type of dialysis?HemodialysisPeritonialHow did you hear about us?InternetNewspaperTV AdMagazineOtherAny Additional Information?CAPTCHA