1) Please enter your Donor ID number. (If you do not know your ID number, enter "00000")
    This number should be located at the top of your Donor Information sheet.

2) Please select the County where you donated blood.

Select County AllenButlerChampaignClarkClintonDarkeDon't KnowGreeneLoganMercerMiamiMontgomeryPrebleRandolphShelbyUnionWarrenWayne

3) Please select the Type of Center where you donated blood.

Donor Center Blood Drive Inside Blood Drive Bus 

3a) Please select the Center (Location) where you donated blood.

     Dayton Dont Know

3a) Please let us know the location where you donated blood.

4) Please rate the welcome you received upon arrival.

Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied 

5) How long was your wait to register to donate blood after your arrival time?

I did not have to wait Less than 5 minutes 5 to 15 minutes 15 to 30 minutes More than 30 minutes 

6) Please rate the insertion of the needle.

Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied 

7) Did staff thank you for giving blood?

Yes No 

8) Please rate your overall experience.

Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied 

9) Based on this donation experience, can we count on your generosity
       for another blood donation in the future?

Yes No 

Why will you not donate again?

10) Please make any additional comments about your donation.