1)Looking at your Donation Number, please enter the 8 numbers shown after W0533.

2)Please select the Location where you donated blood.

Donor Center Blood Drive Inside Blood Drive Bus 

3)Please select the Center where you donated blood.

• Select Center AppletonChicagoGreen BayLittle ChuteMerrillMobileOshkoshRhinelanderWausauWoodruff Dont Know

4)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 

5)Did we make you feel valued and appreciated?

Yes No 

6)Please rate the welcome you received upon arrival.

Totally Satisfied Satisfied  Average Dissatisfied Totally Dissatisfied 

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

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

8)Please rate the professionalism of our staff.

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 

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

Yes, definitely Yes, somewhat No 

11)How likely are you to recommend The Community Blood Center donation experience to a friend, co-worker, or family member in the future?

Very Likely Likely Unsure Not Likely Not at all Likely 

12)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 

13)Please rate your overall experience.

Totally Satisfied Satisfied Average Dissatisfied Totally Dissatisfied 

14)Please make any additional comments about your donation.