Wufoo

Find the Truth About Dialysis

To get your complimentary pair of cozy bedroom slippers, please complete this form, and receive a copy of the Home Dialysis eNewsletter each month! Or call toll free 1-877-TRUTH03 (878-8403) Monday - Friday 8AM - 9:30PM EST to speak with a DaVita Guest Services representative.

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We respect your privacy and will only use your information to send you educational literature and materials related to chronic kidney disease and to contact you about DaVita services that may be of interest to you.
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If you're interested, we'll need your street address to ship you a pair of cozy, one-size-fits-all bedroom slippers. Sorry, we cannot deliver to PO, APO or FPO Boxes.
Find the Truth About Dialysis - Local events & programs

Please revisit our website regularly or check the box below to receive email notification of dates and times of future Find the Truth About Dialysis events or programs in your area.
By checking this box, I am indicating that I want to be notified by email about future Find the Truth About Dialysis events or programs.
Receive a pair of cozy bedroom slippers!

Provide both a valid street address and email when submitting this form and we'll send you a copy of the Home Dialysis eNewsletter each month by email. We'll also ship you a complimentary pair of cozy bedroom slippers as our gift to you - free of charge. You must provide a valid street address within the continental US and your email in order to receive this offer. Offer not available to residents of HI & AK. Other restrictions apply.
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Yes! I would like to receive a complimentary pair of slippers, the monthly Home Dialysis eNewsletter and other information about home dialysis.
To best provide you with information about chronic kidney disease & kidney care options that suits your interests or needs, please complete the brief survey below. When done, click Submit.
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a DaVita patient / patient family member a non-DaVita patient / patient family member a Healthcare Professional a DaVita teammate / employee Other / do not want to specify

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If you are a patient or family member of a patient, please indicate type below.
I'm a Chronic Kidney Disease patient / patient family member I'm Pre-dialysis / patient family member I'm an In-center hemodialysis patient / patient family member I'm a Peritoneal dialysis patient / patient family member I'm a Home hemodialysis patient / patient family member I'm an In-center nocturnal patient / patient family member I do not wish to indicate
If you are a Healthcare Professional, please select from the list below.
I want to Find the Truth About Dialysis and receive information on: (check all that apply)
Home hemodialysis Peritoneal dialysis In-center nocturnal In-center self care In-center hemodialysis
How did you hear about Find the Truth About Dialysis?
If you heard about Find the Truth when visiting a website or from another source, please indicate here:
I understand that by providing my email address, a valid street address within the continental US, and/or phone number and by clicking ‘Submit,’ I give DaVita Inc., its subsidiaries and DaVita At Home (“DaVita”) permission to send me educational literature and materials related to chronic kidney disease and to contact me about DaVita products and services that may be of interest to me.

If you need assistance with this form or for more information about the Truth About Dialysis, please call toll free 1-877-TRUTH03 (878-8403) Monday - Friday 8AM - 9:30PM EST to speak with a DaVita Guest Services representative.
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Wufoo

Find the Truth About Dialysis

Find the Truth About Dialysis - Local events & programs

Receive a pair of cozy bedroom slippers!

To best provide you with information about chronic kidney disease & kidney care options that suits your interests or needs, please complete the brief survey below. When done, click Submit.