Online Donor Survey

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Thank you for your blood donation. Please take a few minutes to let us know how we are doing by completing the short survey below.

How would you describe your relationship with Kentucky Blood Center? (Select all that apply)

	Current blood donor
	Past blood donor
	Unable to donate blood currently
	Financial donor
	Volunteer
	Blood recipient
	Other:

Before your last donation, did any person or organization ask you to donate blood?

Yes (Who Encouraged You?)

Don't Know

Were you nervous about your last blood donation?

Yes (Mark all that apply)

		I am afraid of needles			I do not like the sight of blood			I was afraid it would make me feel sick
		I was afraid it would hurt

Don't Know

Where did you last give blood?

Thinking of your last donation how would you rate?

a.	How you were greeted by the staff?
b.	The way you were treated by the staff?
c.	The level of privacy during the screening process?
d.	The skill of the staff?
e.	How you physically felt during or after your donation?
f.	The amount of time you waited to make your donation?
g.	Your overall experience?

Thinking about your last donation, how important was each factor in your decision to donate?

a.	Receiving an incentive from the Blood Center, such as a T-shirt.
b.	I believe that I have a duty and responsibility to help others.
c.	I wanted to feel good about myself for helping other people.
d.	I wanted to help in a community crisis.
e.	I was encouraged by family, friends or co-workers.
f.	I wanted to reach a target number of donations.
g.	I saw or heard an appeal on the TV, radio or in the newspaper.
h.	I received a request from the Donor Center.
i.	I needed blood or knew of someone who needed blood.

How likely is it that you will give blood again?