Have Feedback?

Hospital Services Feedback Form

Required information is followed by the * symbol.

Referral Number or Patient's Last Name

Hospital Name*

Unit*

Did you make the initial referral call?

How would you rate the response time to your hospital (when Infinite Legacy representative arrived)?

Excellent

Good

Needs Improvement

N/A

Comment

How would you rate your experience with the Infinite Legacy on-site representative?

Excellent

Good

Needs Improvement

N/A

Comment

The donation process was explained to me in enough detail that I felt comfortable in my role and the next steps to follow:

Strongly Agree

Agree

Disagree

N/A

Comment

Infinite Legacy came on site to speak with the family about organ donation.

The care team and Infinite Legacy huddled to make a plan for the meeting:

Yes

N/A

Comment

Infinite Legacy was supportive of the family and communicated respectfully during the meeting:

Yes

N/A

Comment

Did the patient become an organ donor?

Yes (Go to next question)

No (Skip next question)

N/A

Comment

The donor management phase was a collaborative process and I felt well informed about my role:

Yes

N/A

Comment

How would you rate your overall experience with Infinite Legacy?

Excellent

Good

Needs Improvement

Comment

Please provide any additional information or comments below:

Don't fill this field!

Hospital Services Feedback Form

Hospital Services Feedback Form

Thank You

Connect