The following feedback takes less than 10 minutes, and will greatly assist KPBD to help you better in upcoming events.

Your Name

Your Email

Your Mobile Number

Your Gender
MaleFemale

Your Blood Group (Required)
A+A-B+B-AB+AB-O+O-Don't Know

Your Age (Required)
---18-2425-3435-4445-5455-6465+

Have you ever donated blood? (Required)
YesNo

If yes, how many times within the last 2 years? If no, proceed to next question.

What prompted you to donate blood? (Required)
Emergency call for blood donationTo ensure that blood would be there if you or a loved one ever neededCommunity support

Other (please specify)

On a scale of 1-5 where 1 = "Completely Disliked" and 5 = "Completely Liked", please indicate your level of Dislike or Like with the following statement.

Do you satisfy from KPBD
YesNo

In either case please specify

KPBD Reception
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KPBD Registration
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Blood Bank Reception
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Blood Bank Registration
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KPBD Form Filling Support
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KPBD Doctors Room Support
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KPBD Donation Room Support
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Certificate Distribution
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Food
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Water and Juice
12345

Media
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Do you have any comments-concerns you would like to share with KPBD?

KPBD contact with me whenever there is any blood donation appeal
YesNo