Abstract Background and Aims The great number of resources needed for hemodialysis treatment can be a limiting factor in the perspective of access to care, especially in developing Countries, and may have a negative impact on the environment. The aim of the study was to develop a questionnaire that is easy and informative of the ecologic impact (energy costs and waste production) of a single dialysis center. The questionnaire's goal is to highlight potentially modifiable factors that are responsible of the ecologic footprint of dialysis. Method A team of 8 people, 3 nephrologists, 3 representatives of dialytic equipment companies and 2 of water treatment systems, developed the questionnaire. The items have been decided after two meetings in person. The completed questionnaire included 49 items divided into three sections, exploring the organization techniques of the dialysis center, its consumption and its water treatment system's characteristics. The questionnaire was then submitted to 11 dialysis centers and made available from 30 September 2022 to 1 February 2023, and included data collected in May 2022. An investigator assisted within filling in the form and collecting feedback on the comprehension of the questions and on any problems that may have surfaced during the compilation of the questionnaire. Results The questionnaires were completed by the center's managers who, unanimously, thought that the form was easily understandable and without significant problems during the compilation. The data collected evidenced that there is almost no real knowledge of the center's consumptions and that also many data about power and water consumption and of waste production are ignored and are therefore missing. No center is fueled by renewable energies. Data refers to a total of 10337 dialysis treatments, with an average 940 treatments per center. Electrical consumption and waste production are in line with the literature, with an average of 13 KwH and 1,9 kg consumption per treatment, respectively. The average water consumption in our sample (550 L per treatment) seems to be higher than expected. Standard dialysate flow was greater than or equal to 500 ml/min in both HD and HDF, except in two centers. Five centers had a water treatment system which is more than eight years old. Average values of each center are reported in the Table 1. Conclusion Our questionnaire appears to be an easily fillable option to carry out consumption “screenings” of each dialysis center. The form could also prove itself useful for a large-scale investigation, to collect an adequate amount of data and to conduct a thorough research to highlight critical issues that could affect the center's consumption. A wider spread of this questionnaire could improve the awareness of nephrologists about their dialysis structure's consumption, taking part in the cultural revolution which is needed to develop a “greener” nephrology.