Transplant Surgery »  Patient Center »  Kidney Transplant »  New Patient Information and Forms

Preparing For New Patient Transplant Evaluation Appointment

Note: This page is intended for new kidney transplant patients with a scheduled evaluation appointment.

Below you will find instructions, forms and other materials for your upcoming evaluation appointment. Please review and complete the required forms which can be filled out online and then printed.

Health History Questionnaire (Required) 

Online Medical History Questionaire

Additional Forms to Complete (Required) 

Authorization for Release of Health Information
Informed Consent To Evaluate
Notice of Privacy Practices (Form)
Questions & Answers for Transplant Candidates about Multiple Listing and Waiting Time Transfer
Terms and Conditions of Service 

Evaluation Videos (Please View Prior to Appointment):

Kidney Transplant Evaluation Video (English)
Kidney Transplant Evaluation Video (Spanish)
Kidney Transplant Evaluation Video (Cantonese)
How Organs are Distributed

Living Donor

Living Donor Kidney Video (English)
Living Donor Kidney Video (Spanish)
We are Transplant: Stories from the Novartis Transplant Games (Videos of the Gift of Living Donation)
  

Educational Materials

Insurance Information About Your Transplant (English)
Insurance Information About Your Transplant
(Spanish)
Insurance Information About Your Transplant
(Chinese)
Introduction: Your Health Matters

Notice of Privacy Practices (Brochure)
Post-Transplant Outcomes Data
Kidney Allocation

Forms of Identification (Required):

  • Photo ID
  • Health Insurance Card

For Questions or to Learn More:

UCSF Kidney/Pancreas Transplant Team
Connie Frank Transplant Center
University of California, San Francisco
Kidney/Pancreas Transplant Services
400 Parnassus Ave. 7th Floor, Suite 701
San Francisco, CA 94143-0116
(415) 353-1551

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