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Blood Donor Center Survey

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Thank you for donating blood. People like you make a difference for the children at Childrens Hospital Los Angeles. To assist us in providing a comfortable and pleasant experience for you, please take a few minutes to complete this brief survey. Thank you.

Your Name (Optional) 
Is this the 1st time you are donating for Childrens Hospital Blood Donor Program? Yes
 No
 I do not recall
Where did you donate for Childrens Hospital? Childrens Hospital Campus
 On the Maxmobile Bus
 Mobile - Not on the Maxmobile Bus
 I do not recall
How did you learn about the Blood Donor Center? Blood Drive at place of employment/neighborhood
 Doctor referral
 Friend/family member
 Donor center called me
 Website
 Other Advertising
 I do not recall
On a scale of 1 to 5 (5 being best) please rate the following components of your blood donation experience at Childrens Hospital.
The way you were greeted by the staff  1    2    3    4    5    N/A   
The way you were treated by the staff 1    2    3    4    5    N/A   
The level of privacy when you were completing your questionnaire 1    2    3    4    5    NA   
The level of privacy when one of our staff members was discussing your questionnaire with you 1    2    3    4    5    N/A   
The skill level of the staff 1    2    3    4    5    N/A   
The amount of time you had to wait 1    2    3    4    5    N/A   
Quality of refreshments 1    2    3    4    5    N/A   
Your overall donation experience 1    2    3    4    5    N/A   
Will your company or place of worship sponsor a blood drive? No    Yes   
If yes, please state your company name and contact person 
Comments
Suggestions for Improvements