MotherToBaby Utah Satisfaction Survey
MotherToBaby Utah is partially-funded by a federal grant. In an effort to keep our funding and to better evaluate our service so we can continue being able to answer questions like yours, we hope you will answer several quick questions about the service you received. Your identity will not be shared and you will not be re-contacted by MotherToBaby Utah about this survey. We estimate it will take 2 minutes to complete the questions below. You may skip any questions that do not apply. Thank you.
Also, we need your help to better answer questions for moms in the future. Your participation in observational research studies will help us provide better answers. Individuals or provider offices can call us for more details at 801-328-2229.
MotherToBaby Utah is facing budget cuts starting October 2019. Please help us keep our service open by letting us know if you would like to make a donation or if your organization would like to partner with, sponsor, or fund MotherToBaby Utah. Thank you.
What is your ZIP/postal code?
What date did you contact us?
Before your contact (call, text, email, etc.) today, how concerned were you about the reason you called MotherToBaby (scale of 1 to 5)?
Were your concerns understood by the specialist that answered your questions?
Was the information provided to you helpful (scale of 1 to 5)?
If not helpful, why not?
Has the information you received affected your understanding or actions about the reason (exposure) you called?
Please explain your above answer.
Would you have preferred any other way to be able to contact/receive information from us?
Over the phone
Via private live online chat
Via an app on your mobile device
Via standard U.S. mail
Is there anything specific that you feel would have improved the service you received today?
Thank you so much for taking the time to provide us with feedback! If you have any additional questions, please don't hesitate to contact us again toll-free in Utah 800-822-2229 or in North America at 866-626-6847.
Please add any additional comments or suggestions:
What is your age?
What is your race/ethnicity
What is the annual income for the entire household?
$25,000 to $50,000
What is the highest level of education you have finished so far?
No High School
Some High School
High School Graduate / GED
What is the name of the insurance plan that you have?
Blue Cross / Blue Shield, Regence
Add a testimonial to be shared on the MotherToBaby Utah website. Use your initials at the end of the testimonial to show your permission to post the testimonial. Thank you.
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This form was created inside of State of Utah.