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. (If you do not know your ID number, enter "00000")
    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) 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?
    
 
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 
 
6) Did we make you feel valued and appreciated ?
     Yes No 
 
7) If you made an appointment , was your appointment time honored?
     Yes No Did not make an appointment 
 
8) Please rate the ease of making your appointment
     Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied 
 
9) Please rate the welcome you received upon arrival.
     Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied 
 
10) How long was your wait to register to donate blood after your arrival time?
     I did not have to wait Less than 5 minutes 5 to 15 minutes 15 to 30 minutes More than 30 minutes 
 
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, somewhat 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) Did staff thank you for giving blood?
     Yes No 
 
17) Please rate your overall experience.
     Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied 
 
18) 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?
    
 
19) 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 
 
20) Please make any additional comments about your donation.

    
 
Please provide us contact information to help serve you better.
Name   (Required)
Email Address 
Address   (Optional)
City   (Optional)
State   (Optional)
Zip   (Optional)
Phone   (Optional)