GF Donor Survey Donor Survey Donation LocationsWhere are you donating today?* Laurel Diamond Fairbanks Mobile Date* MM slash DD slash YYYY Donor DemographicsSex* Male Female Age* Under 18 18-24 25-34 35-44 45-54 55+ Ethnicity* White Hispanic African American Alaskan Native Asian Other Zip Tell Us About Your ExpericenceOn a scale from 1 to 5 (5 being the best) please rate the following components of your blood donation experience at Blood Bank of Alaska.. The way you were greeted by staff 1 2 3 4 5 The way you were treated by staff 1 2 3 4 5 Professional level of staff during screening 1 2 3 4 5 The skill level of our staff- Phlebotomy 1 2 3 4 5 Cleanliness of our location center/coach 1 2 3 4 5 Your overall donation experience 1 2 3 4 5 Did you have an appointment?* Yes No How long did you have to wait?* 15 minutes 30 minutes More Is this your first time donating?* Yes No How many times a year do you donate?* 1 2 3 4 5 more Have you or someone you know received a blood transfusion?* Yes No What motivated you to donate today?* Friends Work Advertisement Civic Duty Helping Others Other What is the biggest obstacle to overcome when trying to donate blood?* Time Fear Finding a Location Health Questions Concerns About Usage of Blood Other Will your company or place of worship sponsor a blood drive?* Yes No Already Does How did you hear about Blood Bank of Alaska?* TV Radio Newspapers Website Word of Mouth Work Social Media Other Comments/Suggestions
