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Chronic Kidney Disease Patient Questionnaire Mobile App

The Papa Johns Feedback Form mobile app makes it easy for customers to submit pizza feedback electronically. The customer satisfaction app was designed for Papa Johns feedback, but can be customized for any type of pizza customer feedback survey.

The customer satisfaction survey form records comments from both employees and customers of the pizza restaurant. These comments may vary from the quality of the food, to experiences with the website or ordering app. The form also includes optional fields for email address, phone number, zip code and more.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Chronic Kidney Disease Patient Questionnaire Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    You have most likely been referred to this clinic by a health care professional or yourself to ad...

  • Ico dropdown

    Have you ever been told you have kidney disease?

  • Ico dropdown

    How long has it been since you were first diagnosed?

  • Ico statictext

    How was this diagnosed?

  • Ico checkbox

    Blood test (elevated creatinine)

  • Ico checkbox

    Protein in the urine

  • Ico textbox

    Other:

  • Ico multiline

    Have you been told what caused your kidney disease (e.

  • Ico statictext

    5. Have you ever had any of the following (Check if yes):

  • Ico checkbox

    Kidney problems at birth or in childhood?

  • Ico checkbox

    Hospitalization due to kidney failure?

  • Ico checkbox

    Kidney failure while hospitalized for another reason?

  • Ico checkbox

    Kidney stones?

  • Ico checkbox

    Bladder or kidney infections?

  • Ico checkbox

    Difficulty emptying your bladder?

  • Ico checkbox

    Bladder or other urologic surgery?

  • Ico checkbox

    Radiation to the abdomen or pelvis?

  • Ico checkbox

    Chemotherapy for cancer?

  • Ico checkbox

    Family history of kidney disease?

  • Ico checkbox

    Blood in the urine?

  • Ico checkbox

    Foamy urine?

  • Ico multiline

    If you answered yes to any of the above, please enter more details here:

  • Ico dropdown

    Do you use regularly pain or anti-inflammatory medicines or NSAIDS (i.

  • Ico dropdown

    a.

  • Ico dropdown

    Do you use herbal supplements?

  • Ico multiline

    a.

  • Ico dropdown

    Do you have high blood pressure or take medicine for high blood pressure?

  • Ico dropdown

    How long ago were you first diagnosed?

  • ...and More!

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