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Please Complete Our On-Line Donor Survey


Thank you for donating blood.  People like you make the difference between life and death for hundreds of patients in our community hospitals each year.  

We can continue to fulfill our mission of saving lives only if our donors enjoy giving with us and are willing to return to give the gift of life again.  To assist us in providing a comfortable and pleasant experience for you, please complete this brief survey and submit it.  Thank you.

(* = required field)

Note: If you wish a response, please include your
Email Address or Phone Number.
* Date of your donation:
Email or Phone # (optional):
* Last Name:
* First Name:
What type of donation?

Where did you donate blood?
Were you welcomed promptly and courteously when you entered?
Yes
No
Did we provide a clean, pleasant 
environment for your blood donation?

Yes
No
Did we take time to answer any questions or concerns you had about the donation process?
Did we make this an enjoyable donation for you?
Yes
No
Did we thank you for giving blood?
Yes
No

What prompted you to donate with us?
If you chose "other" for the previous question, please specify your reason?

  Will you donate with us again?
  Yes
  No
If no, what can we do to improve our service for blood donors?

  I am a:
  New donor
  Repeat donor

What was your overall impression of your donation experience?


Do you belong to a school, religious or civic organization, or business that would be interested in sponsoring a blood drive with us?
Yes
No
If yes, name and address of organization:
 

Name of person to contact:

Phone or email address:

 


Would you like to be added to the blood center's mailing list?
Yes
No
If yes, please indicate your email address here: (all information will be kept confidential)

Thank you.

               


The Blood Center of New Jersey
45 South Grove Street
East Orange, New Jersey  07018
1-800-NJBLOOD
1-973-676-4700

Copyright 2001 by The Blood Center of New Jersey. All rights reserved.