Online Donor Survey

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.
1. 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:
 
2. Before your last donation, did any person or organization ask you to donate blood?
 
Yes (Who Encouraged You?)
  Family Member    Friend    My Employer  
  Co-worker    My school    My doctor  
  Religious Organization    Social/Civic Group    Someone from Blood Center  
No
Don't Know
 
3. 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  
No
Don't Know
 
4. Where did you last give blood?
   
 
5. 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?
 
6. 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.
 
7. How likely is it that you will give blood again?
   
 
Submit Survey