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POST REFERRAL FEEDBACK
Thank you for taking the time to fill out this brief survey. All information provided in this survey will be kept confidential and will enable us to better serve our donor families and hospital partners. Please be sure to provide both a referral number and the name and contact information of an appropriate person for us to reach out to regarding your feedback.

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* 1. Referral Number:

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* 2. Hospital Name:

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* 3. How would you rate your experience with the initial referral call?

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* 4. How would you rate your experience working with the OneLegacy Coordinator at your hospital?

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* 5. Once in the hospital, OneLegacy staff acted in a professional manner and was respectful of the staff and facilities.

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* 6. How would you rate your experience with the OneLegacy Coordinator communicating on the status of the referral or case?

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* 7. The Donation Process was explained to me in enough detail that I felt comfortable in my role.

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* 8. The OneLegacy staff helped the hospital staff appropriately throughout the case.

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* 9. The OR Process was explained to me in enough detail that I felt comfortable in my role.

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* 10. How would you rate your overall experience with OneLegacy?

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* 11. Please provide the name and contact information of an appropriate person for us to reach out to regarding your feedback.

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