Memorial Blood Centers Donor Survey

Welcome to your Memorial Blood Centers Donor 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 medical concerns please contact us at 612-201-4654 between 7:30 and 4:00 or after hours at 651-332-7108.
1) Please locate your Donation number on your DONOR Care Guide. Enter the 8 numbers shown after W0515.

2) Please select the Location where you donated blood.
Donor Center  Blood Drive Inside  Blood Drive Bus  
3) Please select the Center where you donated blood.
4) 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  
5) Did we make you feel valued and appreciated ?
     Yes  No  
6) If you made an appointment , was your appointment time honored?
     Yes  No  Did not make an appointment  
7) Please rate the ease of making your appointment
     Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  
8) Please rate the welcome you received upon arrival.
     Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  
9) Please rate the total time you felt you were unnecessarily waiting during the entire donation process.
     I did not have to wait unnecessarily  Less than 5 min  5 to 15 min  15 to 30 min  Over 30 min  
10) Please rate the friendliness of our staff.
     Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  
11) Please rate the professionalism of our staff.
     Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  
12) Please rate the insertion of the needle.
     Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  
13) Did you feel that the blood collection staff was skilled and competent?
     Yes, definitely  Yes, sometimes  No  
14) Was the donor center or blood drive as clean as it should be?
     Yes, definitely  Yes, somewhat  No  
15) How well organized was the donor center or the blood drive?
     Very organized  Somewhat organized  Not at all organized  
16) Will you donate again in the next 6 months?
     Yes, definitely  Yes, probably  No  
17) How likely are you to recommend this Memorial Blood Centers donation experience to a friend,
       co-worker, or family member in the future?
     Very Likely  Likely  Unsure  Not Likely  Not at all Likely  
18) 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  
19) 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?
20) Please rate your overall experience.
     Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  
21) Please make any additional comments about your donation.

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