Help Loving Bottoms Diaper Bank Help You!
We want to make sure our diapers are making a difference for you and your family. Your feedback helps us to get rid of the not so helpful stuff and make the helpful stuff more helpful. Please take a minute to fill out our survey and we promise to keep your answers private and anonymous. Thank you so much!
Agency where you get your diapers
Your answer
Have you gotten diapers from any other organizations?
Your answer
Zip Code where you live
Your answer
How many adults live in your household?
Your answer
Check all that apply of the adults in your household
How many children aged 0-3 live in your household and are using diapers?
Your answer
Are there children over age 3 wearing diapers?
Please select your appropriate employment status
Is your household receiving any additional income/cash assistance from sources other than a job?
Please check all that apply.
Do you receive SNAP (food stamps)?
Do you receive WIC?
How much was your total household income last year?
Select the closest range.
Did your child have any of the following problems before you started using the diaper bank/agency to get diapers?
Check all that apply.
Has a limited supply of diapers ever prevented your child from attending childcare/daycare?
If you responded yes to the question above, did you have to miss work or school?
Check any of the statements below that are true for your family
If/when you don't have enough diapers, which of these things do you experience?
Check all that apply.
If/when you don't have enough diapers what do you do?
Check all that apply.
When I get diapers from the diaper bank/agency...
Check all that apply.
Which of these things are you possibly interested in learning more about?
Check all that apply.
Comments
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Loving Bottoms Diaper Bank. Report Abuse