Nurturing Bonds Breastfeeding Consultation Feedback and Evaluation Form
If you have had more than one consultation, please fill this form out for each one if you prefer or for your overall experience. I appreciate your feedback so much. It will help me to continually improve and offer the best breastfeeding support I can give to mothers.
What date and location did I meet with you? *
Your answer
Did you find the instruction and support you received to be helpful to improve your breastfeeding relationship?
Your answer
What did you think about the location? Would you have preferred doing a consultation elsewhere?
Your answer
What was the best part of the consultation?
Your answer
What helped you the most?
Your answer
What was your least favorite part of the consultation?
Your answer
What helped you the least?
Your answer
Was there anything you wish we would have discussed but didn't?
Your answer
Was there anything about the consultation you would have changed or added?
Your answer
Have you referred to the doctor's report since I sent it to you? Do you know if your doctor received it?
Your answer
If you received any handouts, was there anything that was especially helpful? Anything that you didn't feel was necessary?
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Are there any handouts that you didn't receive that you wish you would have?
Your answer
Are there any other things that you wish we would have worked on hands on but didn't?
Your answer
If we used any tools together did you find them helpful? Why or why not?
Your answer
Do you feel equipped with the knowledge and resources you need to go forward? Why or why not?
Your answer
Do you know who to reach out to for follow up care if necessary? Who is that? Where did you hear about them?
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Please, if you're comfortable, tell me about your breastfeeding experience since our consultation.
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Is there anything else you would like to add about the consultation to help me better instruct parents in the future?
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Would you recommend a consultation with me to a friend? Why or why not?
Your answer
Did you feel that you received your "money's worth" with this consultation? Why or why not?
Your answer
Would you be willing to give a testimonial for lactation consultations that could be published in my marketing materials and on my website? Please write a line or a few lines and include your first name and last initial with or your full last name (whichever you would prefer to be published). If you would like to give a testimonial but remain anonymous, that's fine too. (Not all testimonials will be published and no monetary or other compensation will be given for a testimonial.
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