Stanford Medicine

Donor Satisfaction Survey

Dear Donor,
The following questionnaire is about your visit and donation experience at the Stanford Blood Center. Please check the box (es) that best describe your answer(s). At the end of the questionnaire, you will have the opportunity to write additional comments. Thank you for participating in our study!

Page 1 of 4

Please indicate the location where you last donated blood:

Palo Alto

Mountain View

Blood Drive

Please name the site:

Please indicate your gender:

Male

Female

Please indicate your age group:

17 - 25

26 - 35

36 - 45

46 - 55

56 - 65

66 and above

(Optional) Please indicate the date and approximate time of donation:

Date
Time

During your most recent visit, what type of donation did you make?

	Automated Blood Collection (ABC)
	Whole blood for the community
	Designated donation to a patient
	Whole blood for myself (autologous)
	Donation for research purposes
	Other

Please specify:

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How many times have you donated blood in the last 12 months?

	This is my first time to donate blood.
	One or two times
	Three or more times

How did you learn about the Blood Center? (Please check only one box)

	There was a blood drive at my workplace/organization
	Doctor referred me (to give blood for myself or someone else)
	A friend or family member referred me
	The Blood Center called me (phone)
	Through an advertisement (news, flyer, radio)
	I do not recall
	Other

Please specify:

During your donation experience, how satisfied were you with the service of the following blood center personnel:

a.	Appointment
b.	Registration
c.	Medical Historian
d.	Phlebotomist
e.	Refreshment Area

Did you have to wait longer than anticipated before giving blood? (If answer is "No", please skip next question)

Yes

10.

At what point did you have to wait too long?

	Before signing in (registration)
	Before your medical history was taken
	Between your medical history and actual donation
	On second thought, I never felt like I had to wait too long

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11.

Compared to the last time you gave blood, your most recent donation experience was:

	Much Better
	Somewhat better
	About the same
	Much Worse
	NA (first time)

12.

Indicate the extent to which each of the following has kept you from donating more often:

a.	My work or study schedule
b.	Being tired
c.	Family or social commitments
d.	Discomfort or fear of needles
e.	Reached maximum allowable donations
f.	Fear of being deferred
g.	Blood Center hours
h.	Blood Center location(s)
i.	No reminders from the Blood Center
j.	Poor customer service

13.

Indicate how likely it is that you will recommend Stanford Blood Center to others:

Very Likely

Moderately Likely

Not likely

Not likely at all

14.

Overall, how satisfied were you with your most recent visit?

	Very Satisfied
	Moderately Satisfied
	Moderately Unsatisfied
	Very Unsatisfied

15.

How do you prefer to be contacted about donating blood?

Phone

Mail (postcard)

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Donor Satisfaction Survey

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