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Tissue Donor Assessment

Thanks to the generosity of donors and their families, thousands of lives are saved and quality of life is restored every year.

To ensure we are providing meaningful services for donor families, we are asking you to complete this questionnaire. The information you share is invaluable and will allow us to understand your experience with the donation process and LifeGift. The results will also help us offer sensitive care to future donors and their families.

Your Name:*
Your Loved One's Name*
MM slash DD slash YYYY
What is your relationship to the donor? I am his/her/their:*
When thinking about your first conversation with LifeGift, which of the following phrases best describes how you felt:*
What inspired you to donate or support your loved one’s decision to donate? (select all that apply)*

On a scale of 1-4, please rate your experience with the LifeGift coordinator who took you through the donation conversation. 4-Strongly Agree, 3-Agree, 2-Somewhat Agree, 1-Disagree.

When thinking about the length of the entire process from the donation conversation to the time your loved one was at the funeral home, which of the following statements best describes how you feel:*
What kind of funeral did you plan for your loved one?*

Based on your experience, would you be supportive of donation in the future?*
Please confirm whether you received a LifeGift Donation Outcome and Support Packet containing the following items: Donation Outcome Letter, Grief Booklet-Navigating Grief, Donor Certificate/LifeGift Dove*

If you requested follow-up or have questions, please provide your name and contact information below.

Name
Requested follow-up (please check all that apply)