Birth Support Feedback
Please provide feedback regarding my supports and services for me to improve the quality of my services.
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What did you find helpful regarding the prenatal class? *
Your answer
What do you wish we covered more thoroughly during the prenatal class?
Your answer
What did you find helpful regarding the support available leading up to the birth OR what do you wish was different? *
Your answer
Please rate the following:
Poor
Fair
Satisfactory
Very good
Excellent
Please rate the ease of communication with Jackie
Please rate her timeliness for responses
Please rate the speed at which she attended you during labour (if applicable)
Please rate the clarity of the Service Agreement
Jackie provided unbiased information
Value for Fees
Poor
Fair
Satisfactory
Very good
Excellent
N/A
Level of skill/knowledge
Provision of support and empathy
Willingness to provide answers
Props/Supplies available for during the birth (regardless if you chose to use them)
Able to provide a variety of comfort measures
Quality of Back Up Doula provided
Emotional Reponsiveness
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Jackie was caring and empathetic
Jackie was personable to engage with
Jackie demonstrated calm demeanor
I trust Jackie with our prenatal/postpartum care
Jackie was available and helpful
Jackie responded to my feedback
Jackie honoured my experiences/mental health/abilities
What did you like about Jackie's support during your birth?
Your answer
What would you change about Jackie's support during your birth?
Your answer
Support of Infant
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Not Applicable
Jackie provided good information regarding infant care
Jackie demonstrated a caring demeanor for my new baby
Jackie handled my newborn safely
Jackie could give me good tips or tricks to ease my transition to parenting
Jackie had knowledge about newborn wellness or sought satisfactory information when needed
Jackie could give good suggestions regarding breastfeeding/formula feeding/chestfeeding etc.
Jackie made appropriate referrals as needed
What aspects of Jackie's support were most useful or valuable?
Your answer
How would you improve Jackie's services?
Your answer
Why did you choose Jackie as your doula?
Your answer
Important: If you should ever kindly wish to submit a Facebook and/or a Google Review, your name will be placed in a draw for a baby centered gift certificate eligible only for those who provided feedback during the quarter in which you provided feedback. These reviews assist me in reaching new clients and showing up in good placement on Google. No answer required for this section- it's just an FYI.
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