Hospital Partner Feedback
Name
First Name
Last Name
Email
example@example.com
Title
Hospital
Medical Record Number or LifeSource Referral Number
On a scale of 1-5; 5 being the best; how did the donation process go?
1
2
3
4
5
1 is , 5 is
What went right? (example: referral process, communication, donor management, donation process, etc.)
What could have been better? (example: referral process, communication, donor management, donation process, etc.)
Is there any feedback for a specific LifeSource team member?
Was this a complaint?
Yes
No
Reviewed in GTY
Yes
No
Notes
Submit
Should be Empty: