Burdett Birth Center Health Equity Impact Survey

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The Save Burdett Birth Center Coalition is seeking individuals who live in Troy, Rensselaer County and the surrounding areas who have given birth or are planning to give birth at the Burdett Birth Center at Samaritan Hospital. We want to know who will be most impacted by the proposed closure of the BBC and how they will be impacted. Please fill out this survey with as much information as you are comfortable sharing. By participating in this survey, you give us permission to use your responses in our Health Equity Impact Assessment. All personally identifying information will be kept confidential unless otherwise stated.

Email *

Have you given birth at Burdett Birth Center? *

Yes

If yes, when?

Where do you live? *

Are you a member of any of the following medically-underserved groups? Check all that apply. *

Black

Latinx

Woman

Low-income

Uninsured

Medicaid-insured

Living with disabilities

Living with chronic infectious disease, such as HIV or HepC

Living in a rural area

Immigrant or refugee

LGBTQIA+

Prefer not to answer

Other:

Required

How would the closing of the Burdett Birth Center impact you? *

Would you be willing to be interviewed for our Health Equity Impact Assessment? *

Yes

Maybe

Would you be willing to tell your story or speak at a public hearing in Troy on September 18? *

Yes

Maybe

Would you be willing to tell your story or speak at other public events or to members of the media? *

Yes

Maybe

What is your name? *

What is your phone number? *

Do you prefer we reach you by phone or email? *

Phone

Send me a copy of my responses.

Submit

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