Welcome to your Inova Blood Donor Services Survey, and thank you for being a life-saving donor.
Please tell us about your most recent blood donation experience. Your feedback is valuable and will help us improve our services.
This brief survey will only take a few minutes to complete.
For immediate concerns please contact Patricia Freeman, Donor Advocate, at 571-434-3628. |
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1)
Please locate the Unit Number from the front of your Donor Information sheet and enter the 8 numbers
shown after W0898.
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| 2) Please select the Location where you donated blood. |
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Donor Center Blood Drive Inside Blood Drive Bus |
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3) Please select the Center where you donated blood.
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4) Please tell us the name of someone that did a particularly good job?
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5) 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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| 6) Did we make you feel valued and appreciated ? |
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Yes No |
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| 7) 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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| 8) Please rate the welcome you received upon arrival. |
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Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied |
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| 9) Please rate the total time you felt you were unnecessarily waiting during the entire donation process. |
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I did not have to wait unnecessarily Less than 5 min 5 to 15 min 15 to 30 min Over 30 min |
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| 10) Please rate the friendliness of our staff. |
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Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied |
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| 11) Please rate the professionalism of our staff. |
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Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied |
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| 12) Did you feel that the blood collection staff was skilled and competent? |
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Yes, definitely Yes, sometimes No |
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| 13) 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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| 14) 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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| 15) Why did you decide to donate today? |
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Help others Gives me personal satisfaction Do my part for the community Civic/charitable responsibility Saves lives |
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| 16) Did staff thank you for giving blood? |
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Yes No |
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| 17) Did the blood collection staff explain the blood donation process to your satisfaction? |
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Yes, definitely Yes, somewhat No |
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18) How likely are you to recommend this Inova Blood Donor Services donation experience to a friend,
co-worker, or family member in the future? |
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Very Likely Likely Unsure Not Likely Not at all Likely |
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| 19) 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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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) Please rate your overall experience. |
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Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied |
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22) Please make any additional comments about your donation.
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