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Donor Family Survey- Six Months Post-Donation
Every year, thousands of lives are saved as a result of the generosity of donors and families like yours. It has been a privilege for Legacy of Hope (LoH) to meet and work with your family since your loss. We are continually working to improve the care and support provided to families during and after donation. As a family that made the decision to help others through the gift of life, it is important for us to understand your experience. We are asking for your assistance in evaluating your experience with Legacy of Hope by completing this questionnaire. Reflecting upon your experience may be difficult for you; we encourage you to complete the survey as you are comfortable.
Your Loved One's Name:
Your Name:
Your Address:
Email:
Your phone number:
Your relationship to your loved one?
Spouse
Child
Parent
Sibling
Friend
Significant other
Other
What influenced you or your loved one's decision to donate? (check all that apply)
He/she expressed their wishes to be a donor
Desire to help others
Religious or moral beliefs
Story in the media
Other:
Who introduced the subject of donation to your family?
LoH Staff
You or another family member
MD
Nurse
Other:
Was there something that was done during this time that was particularly helpful or supportive to your family?
Please rate the following:
Strongly Agree
Agree
Disagree
Strongly Disagree
Overall, my experience with donation was positive.
Strongly Agree
Agree
Disagree
Strongly Disagree
My loved one's donation has provided me with some comfort.
Strongly Agree
Agree
Disagree
Strongly Disagree
I was treated with compassion and respect by LoH staff at the time of my loved one's death.
Strongly Agree
Agree
Disagree
Strongly Disagree
I was treated with compassion and respect by LoH aftercare staff since the time of my loved one's death.
Strongly Agree
Agree
Disagree
Strongly Disagree
My questions and concerns about my family's experience with donation have been answered to my satisfaction.
Strongly Agree
Agree
Disagree
Strongly Disagree
The following aspects of Legacy of Hope's Aftercare program have been helpful to me:
Family packet
If received, correspondence from recipients
Phone calls
Website (legacyofhope.org)
Other:
Looking back, would you have made the same decision about donation?
Yes
No
Uncertain
If no, please tell us why not:
Follow up:
I have questions about my loved one's donation, please contact me.
I would be willing to speak with others about my experience with donation and LoH.
I would like information on the LoH Ambassadors volunteer program.
I do not want to continue to receive mailings from LoH, please remove my name from your mailing list.
Daytime contact number:
Please feel free to contact the Aftercare Department at 205-801-7353 or
aftercare@legacyofhope.org if you have any questions.
On behalf of the families that will follow you on this journey, we thank you for your thoughts and suggestions.