Please complete this brief survey after your blood donation appointment.

Date of your Donation:

Blood Drive/Site Location:

What motivated you to donate today?

I donate blood every eight (8) weeks. I received a phone call from the Blood Center. I was recruited at my workplace. I heard an emergency appeal through the media. I came with a friend. I saw an advertisement in the Newspaper I saw an advertisement on Television I saw an advertisement on a Billboard I saw an advertisement in a Church Bulletin I saw an advertisement in an E-mail I heard an advertisement the Radio I was asked by the MKBC Collections Staff I was asked by a MKBC Greeter Other

At the time of donation, approximately how long did you wait before screening?

No Wait Less than 5 Minutes More than 5 Minutes

Did our staff say hello, and greet you with a smile?

Yes No

Did the staff make you feel comfortable at registration?

Yes No

Did our screening staff speak in a clear and confidential manner?

Yes No

Did the person who drew your blood introduce him/her self and call you by name?

Yes No

Did our staff members satisfy any questions or concerns you might have had?

Yes No

Did our staff tending to you make you feel appreciated?

Yes No

Overall, did our staff members perform their jobs in a professional and competent manner?

Yes No

Based on this experience, would you donate blood again?

Yes No

Overall, how did we do today, and where do we need to improve?

Would you like us to contact you to discuss any of your responses?

Yes No

Your Name:

Email Address:

Phone Number: