1) Locate your Unit Number near the bottom right of your Post-Donation Instruction Sheet.

•  I do not have my Unit Number.

2) Please select the Location where you donated blood.

3) Please select the Center where you donated blood.

• Select Center Aberdeen Donor CenterAmes Donor CenterAnkeny Donor CenterCedar Valley Donor CenterDowntown Donor CenterFort Dodge Donor CenterJohnston Donor CenterMarshalltown Donor CenterMason City Donor CenterMitchell Donor CenterPella Donor CenterSioux City Donor CenterUrbandale Donor CenterWest Des Moines Donor CenterYankton Donor Center Dont Know

4) Please tell us the name of someone that did a particularly good job?

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

• First time  One to Two times a year  Three to Four times a year  More  

6) Did we make you feel valued and appreciated ?

• Yes  No  

7) If you made an appointment , was your appointment time honored?

• Yes  No  Did not make an appointment  

8) Please rate the welcome you received upon arrival.

• Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  

9) Please rate the total time you felt you were unnecessarily waiting during the entire donation process.

• I did not have to wait unnecessarily  Less than 5 min  5 to 15 min  15 to 30 min  Over 30 min  

10) Please rate the friendliness of our staff.

• Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  

11) Please rate the professionalism of our staff.

• Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  

12) Please rate the insertion of the needle.

• Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  N/A  

13) Did you feel that the blood collection staff was skilled and competent?

• Yes, definitely  Yes, sometimes  No  

14) Was the donor center or blood drive as clean as it should be?

• Yes, definitely  Yes, somewhat  No  

15) How well organized was the donor center or the blood drive?

• Very organized  Somewhat organized  Not at all organized  

16) Will you donate again in the next 6 months?

• Yes, definitely  Yes, probably  No  

17) Did staff thank you for giving blood?

• Yes  No  

18) How did you find out about our patient needs and the donation location you visited?

• Previously donated or called by center  Radio  Internet or e-mail  Postcard or mailing  Other  

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

• Yes  No  

20) Please rate your overall experience.

• Totally Satisfied  Satisfied  Average  Dissatisfied  Totally Dissatisfied  

21) Please make any additional comments about your donation.