EMS Blood Program Survey
Please share your feedback on your experience with the EMS Blood Program. Your input helps us improve our services.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
How did you learn about the EMS Blood Program?
*
EMS Staff
Hospital/Clinic
Social Media
Friends/Family
Other
Please rate your overall satisfaction with the EMS Blood Program.
*
1
2
3
4
5
Please indicate your level of agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The registration process was easy.
1
2
3
4
5
Staff were helpful and professional.
6
7
8
9
10
Information about the program was clear.
11
12
13
14
15
I would recommend the program to others.
16
17
18
19
20
Which of the following best describes your role?
*
Donor
EMS Staff
Family Member of Donor
Other
What motivated you to participate in the EMS Blood Program? (Select all that apply)
*
To help save lives
Personal/family experience with blood needs
Community involvement
Incentives or rewards
Other
Have you participated in any other blood donation programs before?
*
Yes
No
What suggestions do you have for improving the EMS Blood Program?
Additional comments or feedback
Submit Feedback
Should be Empty: