Thank you for being a life-saving donor and welcome to your Community Blood Center Donor Survey.
If you have immediate medical concerns or issues. Please contact us at 1-800-388-4483. Please tell us about your most recent experience of donating blood - Your compliments and concerns will help us to improve our services.
This brief survey should only take a few minutes to answer.
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1)
Please enter your Donor ID number. (If you do not know your ID number, enter "00000")
This number should be located at the top of your Donor Information sheet.
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2) Please select the County where you donated blood.
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| 3) Please select the Type of Center where you donated blood. |
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Donor Center Blood Drive Inside Blood Drive Bus |
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4) Please select the Center (Location) where you donated blood.
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| 5) What prompted you to donate blood today? |
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Advertisement/News Story Special Event Phone Call Post Card Donor Gift Other |
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What prompted you to donate blood today?
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6) How many times have you donated in the last 12 months?
First time One to Two times a year Three to Four times a year More |
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| 7) Did we make you feel valued and appreciated ? |
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Yes No |
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| 8) If you made an appointment , was your appointment time honored? |
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Yes No Did not make an appointment |
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| 9) Please rate the ease of making your appointment |
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Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied |
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| 10) Please rate the welcome you received upon arrival. |
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Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied |
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| 11) How long was the wait after your appointment time? (Or after your arrival time, if no appointment.). |
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I did not have to wait Less than 5 minutes 5 to 15 minutes 15 to 30 minutes More than 30 minutes |
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| 12) Please rate the professionalism of our staff. |
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Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied |
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| 13) Please rate the insertion of the needle. |
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Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied |
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| 14) Did you feel that the blood collection staff was skilled and competent? |
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Yes, definitely Yes, somewhat No |
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| 15) Did the blood collection staff talk in front of you as if you weren't there? |
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No Yes, sometimes Yes, often |
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| 16) Was the donor center or blood drive as clean as it should be? |
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Yes, definitely Yes, somewhat No |
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| 17) How well organized was the donor center or the blood drive? |
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Very organized Somewhat organized Not at all organized |
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| 18) Did staff thank you for giving blood? |
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Yes No |
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| 19) Please rate your overall experience. |
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Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied |
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20) Based on this donation experience, can we count on your generosity
for another blood donation in the future? |
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Yes No |
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Why will you not donate again?
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| 21) How did you find out about our patient needs and the donation location you visited? |
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Previously donated or called by center Radio Internet or e-mail Postcard or mailing Other |
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22) Please make any additional comments about your donation.
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