Welcome to the BREEZE TRANSPLANT™ online health history questionnaire.
Please answer all questions truthfully, accurately, and completely, as the information provided here will be used by our Living Donor Team to detect any medical conditions that may affect your ability to be a living donor.
This questionnaire is confidential. Only health professionals on the Living Donor Team will use this information. This information will not be shared with the transplant candidate or others.
If you need assistance accessing the living kidney donor survey please call 1-415-600-1700 between 8am and 5pm PST to speak to one of our Living Donor team members.