Hope After Loss 2016 Annual Satisfaction Survey
Hope After Loss is funded by donations and grants. In order to continue the work of supporting the pregnancy and infant loss community we ask that you provide us with demographic information to help us better understand the population we serve and obtain funding. Your answers are ANONYMOUS.

All data submitted to this Hope After Loss incorporated 2016 Annual Satisfaction Survey shall be deemed and remain the property of Hope After Loss, Inc. which shall be free to use such data and information for the purposes stated herein. You grant the Hope After Loss 2016 Annual Satisfaction Survey and all other person or entities involved in the operations of Hope After Loss Inc, the right to transmit, monitor, retrieve, store and use your information in connection with the operation of Hope After Loss, Inc.. In providing information or comments through responses to the survey, you grant Hope After Loss, Inc. a non-exclusive license worldwide, perpetual, irrevocable, royalty-free right to exercise the copyright, publicity, database rights (but no other rights) you have in the content in any media known now or in the future.

Zip code
Your answer
Your answer
Relationship Status
Highest Level of Education
What type of losses have you experienced? (Please check all that apply)
How long ago did you have your most recent loss?
Where did your most recent loss take place?
If you recent loss took place in a hospital, please name
Your answer
Please tell us about the location of your other loss(es) (if applicable)
Your answer
Which Hope After Loss services have you utilized (please check all that apply)?
How long after your loss did you utilize one of Hope After Loss's services listed above?
Never submit passwords through Google Forms.
This form was created inside of Hope After Loss, Inc.. Report Abuse - Terms of Service - Additional Terms