Doula Feedback Survey Please let us know how the addition of a doula influenced your pregnancy and birth experience. Name(Required) First Last Phone(Required)Email(Required) Expected Due Date Month Day Year Time Hours : Minutes AM PM AM/PM Actual Date of Baby's Birth Month Day Year Time of Birth Hours : Minutes AM PM AM/PM Please select which hospital you gave birth at.(Required) UPMC Hamot AHN St. Vincent Meadville Medical Center Other Baby's LengthBaby's LengthRate Your Experience Please rate the following on a scale of 1-5 with 1 being less than optimal and 5 being excellentThe doula arrived when expected, was polite and acted in an overall professional manner.(Required)Strongly disagreeDisagreeNeutralAgreeStrongly agreeThe doula was supportive of my decisions as a parent.(Required)Strongly disagreeDisagreeNeutralAgreeStrongly agreeThe doula was able to answer my questions regarding infant care and postpartum recovery, or she was able to recommend a resource to find an answer about which she was uncertain.(Required)Strongly disagreeDisagreeNeutralAgreeStrongly agreeMy family and I felt comfortable having the doula in our home.(Required)Strongly disagreeDisagreeNeutralAgreeStrongly agreeShe encouraged and/or facilitated me practicing self-care.(Required)Strongly disagreeDisagreeNeutralAgreeStrongly agreeShe was able to provide information to local resources when needed.(Required)Strongly disagreeDisagreeNeutralAgreeStrongly agreeIs there anything else you would like to share or would like to provide a testimonial?By entering your testimonial here, you consent to have this quoted to share with potential doula clients.CAPTCHANameThis field is for validation purposes and should be left unchanged.
