Funeral Home Survey
Thank you for helping us honor life through donation by serving donors and donor families. Sharing feedback helps Gift of Life improve processes, which ultimately benefits the families we collectively serve.
Enter Decedent's FIRST name and LAST initial (ex: Robert B.)
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Date of Death
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Month
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Day
Year
Date
Funeral Home name (if multiple locations please be specific).
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Did Gift of Life representatives communicate in a professional manner?
Yes
No
Comments:
Did Gift of Life communicate clearly regarding time frames?
Yes
No
Comments:
Did Gift of Life adhere to the estimated time frames that were communicated?
Yes
No
Comments:
Did preparation of the donor require additional time and resources related specifically to the donation?
Yes
No
Comments:
If preparation required additional time and/or resources, do you plan to request reimbursement?
Yes
No
Comments:
Did complimentary supplies accompany the tissue donor? (Dryene II Gel, union-all,absorbent pads)?
Yes
No
Comments:
If there were personal effects, did the “Donor Belongings” form accompany the donor?
Yes
No
Comments:
Did the family acknowledge the donation during services? Please describe any tributes you facilitated to recognize the donor at the viewing or service.
Yes
No
Comments:
Would you like information about Gift of Life’s Donation Champion Funeral Home Program?
Yes
No
Comments:
Please share any additional information that you would like us to know:
If you would like follow-up on this donor, or regarding any other matter, please provide your contact information and Sharon will contact you!
Your name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: