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Donor Survey: Refreshments
To better serve you, please help us decide which coffee, juice and cookies you prefer.  Thank you.

First Name
Last Name
Email
Contact Phone Number
I donated blood recently at:









As a regular blood donor, how do you rate our overall selection of refreshments?



How do you rate the following:

1. Coffee







Other

2. Juice







Other

3. Cookies







Other

4. Crackers







Other

5. Other

Coffee Questions:

6. Is there a specific brand or flavor of coffee we don’t offer that you would prefer us to carry?

6.1 Brand or flavor of coffee

Juice Questions:

7. I prefer these flavors of juices most! (choose all that apply)

Apple
Orange
Cranberry
Raspberry Lemonade
Fruit Punch
Other Favorite

8. Is there a specific brand or flavor of juice we don’t offer that you would prefer us to carry?

8.1 Brand or flavor of juice

Cookie & Cracker Questions:

9. I prefer these flavors of cookies and crackers most! (choose all that apply)

OREO
Chocolate Chip
Iced Oatmeal
Snickerdoodle
Vanilla Crème
Peanut Butter Crème
Cheese-It Crackers
Goldfish Crackers
Other Favorite

10. Is there a specific brand or flavor of type of cookie/cracker we don’t offer that you would prefer us to carry?

10.1 Brand or flavor of juice


Comments and/or Suggestions:
 

Thank you for giving the Gift of Life and for filling out this questionnaire.

Providing your contact information on our web implies your consent that we can use the contact information you provide in order to get in touch with you via e-mail or telephone. We respect your privacy and we will not share your information.

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