We value your feedback

Your input will help the Brigham and Mass General Brigham better serve our patients, supporters, and community.

Step 1 of 12 - Q1

01. Do you believe in the Brigham’s work to advance care and cures for patients and their families, now and for generations to come?

Yes

02. How do you engage with the Brigham? Please select all that apply.

I have been treated at the Brigham

A family member has been treated at the Brigham

I am or have been employed by the Brigham

I have engaged with the Brigham website and/or social media

I started a fundraiser

I am a donor

I attended an event

I am a volunteer

Other

02a. Other - Please specify:

Please specify:

02b. How recently have you engaged or been involved with the Brigham?

How recently have you engaged or been involved with the Brigham?

Within the past week

Within the past month

Within the past 6 months

Within the past year

Within the past 1-5 years

Other

02b-i. Other - Please specify:

Please specify:

03. Would you like to receive additional updates via email from a personal contact at the Brigham, who will reach out with videos, stories, and information about how we are making an impact on your behalf? (You can opt out at any time.)

Yes, I want to receive occasional emails with updates.

Not at this time.

04. Which aspect of the Brigham and Women’s Hospital mission and vision is most important to you? Please select one.

Pioneering discoveries that will translate into new cures and medical innovations for patients

Delivering personalized care with warmth and compassion in a world-class institution

Revitalizing our hospital campus to provide world-class facilities and technology that enhance patient care

Educating, training, and inspiring the next generation of medical leaders

05. Was there an influential person in your life who inspired your appreciation for the Brigham?

Yes

05a. If yes, please describe your relationship with this person:

If yes, please describe your relationship with this person:

Doctor

Nurse

Brigham Staff Member

Parent or Grandparent

Spouse/Partner/Significant Other

Child/Children

Other Family Member

Friend

Other

05a-i. Other - Please specify:

Please specify:

06. Which of the following specialties do you care the most about?

Cancer

Cardiovascular disease

Primary care

Newborn medicine

Neurologic disease

Other

06a. Other - Please specify:

Please specify:

07. When thinking about future generations, how important is it to you that the Brigham maintains its leadership in patient care and groundbreaking research?

Of the utmost importance

Extremely important

Somewhat important

Not very important

Not important at all

08. Supporters of the Brigham recognize how important it is to develop new cures and treatments and deliver medical breakthroughs. Would you consider furthering our work in any of the following ways?

I already have	I am likely	I am somewhat likely	I am not likely

08a. Donating online with a credit card

Donating online with a credit card

I already have

I am likely

I am somewhat likely

I am not likely

08b. Giving appreciated assets (such as stocks, bonds, land, or real estate)

Giving appreciated assets (such as stocks or bonds, land or real estate, etc.)

I already have

I am likely

I am somewhat likely

I am not likely

08c. Making a gift through my donor-advised fund or family foundation

Making a gift through my donor-advised fund or family foundation

I already have

I am likely

I am somewhat likely

I am not likely

08d. Giving through my IRA account

Giving through my IRA account

I already have

I am likely

I am somewhat likely

I am not likely

08e. Starting a fundraising event

Starting a fundraising event

I already have

I am likely

I am somewhat likely

I am not likely

08f. Participating in an existing fundraiser to benefit your preferred area at the Brigham

Participating in an existing fundraiser to benefit your preferred area at the Brigham

I already have

I am likely

I am somewhat likely

I am not likely

08g. Honoring a doctor, nurse or other Brigham staff member by contributing to a special project called the Helix*

Honoring a doctor, nurse or other Brigham staff member by contributing to a special project called the Helix*

I already have

I am likely

I am somewhat likely

I am not likely

*By giving $2,500 (payable over two years) or more to the Caregivers Fund, you can help us continue to deliver the very best healthcare and also add an inspiring personalized message to the Brigham's Helix display, located in the heart of the hospital.

09. Many people like to include gifts to charity in their will to support causes that are important in their lives. Have you considered making such a gift to the Brigham to benefit future generations?

I have included a gift for the Brigham in my will, trust, or by beneficiary designation.

I am interested in making this type of gift to the Brigham.

Not now, but in the future I would definitely be interested in making this type of gift to the Brigham.

Not now, but in the future I might possibly be interested in making this type of gift to the Brigham.

I am not interested in this type of gift.

09a. Please tell us about your gift (check all that apply):

Please tell us about your legacy gift:

I planned this gift in honor or in memory of someone.

I would like this gift to go to a specific purpose.

Brigham and Women's Hospital may use this gift where it will do the most good.

09a-i. Please provide the name of and/or association with this person:

Please provide the name of and/or association with this person:

09a-ii. Please describe the intended purpose:

Please describe the intended purpose:

09b. Would you like us to provide you with additional resources to help with your decision?

Would you like us to provide you with additional resources to help with your decision?

Easy Ways to Make a Legacy Gift

Time to Update My Plans

Gifts That Pay You Income

10. How does Brigham and Women's Hospital rank in comparison to other organizations or charities you may support?

My top choice for charitable giving

Near the top of my list

Middle of my list

Bottom of my list

Not on my list

10a. Do you have any friends/colleagues/family members with similar interests who would consider supporting the mission and vision of the Brigham?

Do you have any friends/colleagues/family members with similar interests who would consider supporting the mission and vision of the Brigham?

Yes

10a-i. Please let us know the most convenient way to connect:

Please let us know the most convenient way to connect:

I would like to introduce the person(s) to the Brigham on my own.

I would like the Brigham to provide me with resources to share with the person(s).

Our team is here to help! If you have any questions or concerns about your patient experience that you would like us to address, please reach out directly to Patient Family Relations at 617-732-6636 or ptrelations@partners.org.

11. About You (optional)

11a. Age

Age

Under 40

40 - 49

50 - 59

60 - 69

70 - 79

80 - 89

90+

11b. Gender

Gender

Male

Female

Other

Prefer not to specify

11c. What is your marital status?

What is your marital status?

Married/Lifetime Partner

Not married/Divorced

Widowed

11d. Which of the following best describes your family?

Which of the following best describes your family?

I have no children

I have one child

I have two or more children

11e. Please tell us the highest level of education you completed:

Please tell us the highest level of education you completed:

High school graduate or equivalent

Some college

Associate's degree

Bachelor's degree

Advanced degree

11f. Please select the option(s) that best describes your professional life.

Please select the option(s) that best describes your professional life.

Working full time

Working part time

Retiring within 5 years

Retired

Do not intend to retire

Volunteering

Board member for a nonprofit

Business owner or entrepreneur

Self-employed

Other

11f-i. Profession:

Profession:

11f-ii. Where do you serve as a board member?

Where do you serve as a board member?

12. Please check the box below if you would like to update your contact information.

I would like to update my contact information.

First name(Required)

Last name(Required)

Address

Address 2

City

State

ZIP

Country

Phone

Email(Required)

Name

This field is for validation purposes and should be left unchanged.

We value your feedback

How is this information used?