Community Blood Center Donor Survey

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.
1) Please enter your Donor ID number.
    This number should be located at the top of your Donor Information sheet.

    
 
2) Please select the County where you donated blood.

    
 
3) Please select the Type of Center where you donated blood.
Donor Center  Blood Drive Inside  Blood Drive Bus  
 
4) Please select the Center (Location) where you donated blood.

    
    
 
5) What prompted you to donate blood today?
     Advertisement/News Story  Special Event  Phone Call  Post Card  Donor Gift  Other  
    What prompted you to donate blood today?
    
 
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  
 
7) Did we make you feel valued and appreciated ?
     Yes  No  
 
8) If you made an appointment , was your appointment time honored?
     Yes  No  Did not make an appointment  
 
9) Please rate the ease of making your appointment
     Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  
 
10) Please rate the welcome you received upon arrival.
     Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  
 
11) How long was the wait after your appointment time? (Or after your arrival time, if no appointment.).
     I did not have to wait  Less than 5 minutes  5 to 15 minutes  15 to 30 minutes  More than 30 minutes  
 
12) Please rate the professionalism of our staff.
     Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  
 
13) Please rate the insertion of the needle.
     Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  
 
14) Did you feel that the blood collection staff was skilled and competent?
     Yes, definitely  Yes, somewhat  No  
 
15) Did the blood collection staff talk in front of you as if you weren't there?
     No  Yes, sometimes  Yes, often  
 
16) Was the donor center or blood drive as clean as it should be?
     Yes, definitely  Yes, somewhat  No  
 
17) How well organized was the donor center or the blood drive?
     Very organized  Somewhat organized  Not at all organized  
 
18) Did staff thank you for giving blood?
     Yes  No  
 
19) Please rate your overall experience.
     Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  
 
20) Based on this donation experience, can we count on your generosity
       for another blood donation in the future?
     Yes  No  
    Why will you not donate again?
    
 
21) How did you find out about our patient needs and the donation location you visited?
     Previously donated or called by center  Radio  Internet or e-mail  Postcard or mailing  Other  
 
22) Please make any additional comments about your donation.

    
 
Name   (Optional)
Email Address 
Address   (Optional)
City   (Optional)
State   (Optional)
Zip   (Optional)
Phone   (Optional)