Florida Coalition on Donation

Survey

Please take a moment to fill out our brief survey

Which of the following statements best describes your wish to have your organs or tissue donationed after your death?

I wish to donate all my usable organs and tissue.

I wish to donate only certain organs and tissue.

I have not yet decided if I want my organs/tissue donated.

I am reluctant to have my organs or tissue donated.

I do not wish to have my organs or tissue donated.

Which of the following ways, if any, have you indicated your wishes regarding organ or tissue donation?(Select as many as apply.)

	Told a member of my family that I wish to have my organs or tissue donated.
	Told a member of my family that I do not wish to have my organs or tissue donated.
	Told a friend that I wish to have my organs or tissue donated.
	Told a friend that I do not wish to have my organs or tissue donated.
	Indicated in a Living Will that I wish to have my organs or tissue donated.
	Indicated in a Living Will that I do not wish to have my organs or tissue donated.
	Indicated on my driver’s license that I wish to have my organs or tissue donated.
	Indicated on my driver’s license that I do not wish to have my organs or tissue donated.
	Signed up on an organ or tissue donor registry.
	Signed a donor card.
	None of the above.

Are you a Florida Resident?

Yes

How did you hear about Donate Life Florida?

Web Search

Magazine or Newspaper Article

Word of mouth

Get Carded

Workplace Partnership For Life

Other: