Milk Donation Feedback Survey
Help us improve by sharing your experience with our milk donation process.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number (optional)
Please enter a valid phone number.
Format: (000) 000-0000.
How did you first hear about our milk donation program?
*
Please Select
Hospital/Clinic
Social Media
Friend/Family
Website
Other
Please rate your overall experience with the milk donation process.
*
1
2
3
4
5
Please evaluate the following aspects of your donation experience:
*
Rows
Very Poor
Poor
Average
Good
Excellent
Ease of scheduling donation
1
2
3
4
5
Staff professionalism
6
7
8
9
10
Cleanliness of facility
11
12
13
14
15
Clarity of instructions
16
17
18
19
20
Communication before donation
21
22
23
24
25
What motivated you to donate milk? (Select all that apply)
*
Desire to help others
Surplus milk supply
Personal experience with milk donation/need
Recommendation from healthcare provider
Other
How likely are you to donate milk again in the future?
*
Very unlikely
Unlikely
Neutral
Likely
Very likely
What challenges, if any, did you face during the donation process?
Do you have any suggestions to improve our milk donation program?
Would you recommend our milk donation program to others?
*
Yes
No
Not sure
Submit Feedback
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