Center for Birth Satisfaction Survey

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Your name (optional, but appreciated)

Your Midwife's Name/Practice

Please indicate which response most closely matches your opinion.

Completely Disagree

Somewhat Disagree

Neither Agree nor Disagree / Neutral / N/A

Somewhat Agree

Completely Agree

My midwives were good about explaining the logistics around meeting at the Center for Birth birth center when in labor.

My midwives were good about explaining where to park at the Center for Birth birth center.

The birth suite was comfortable.

The birth center seemed well equipped.

I was satisfied with the birth center.

I am dissatisfied with some things about the care I received (explain below).

My midwives were good about explaining how to register at the Center for Birth birth center.

If I had any contact with Center for Birth staff, they were courteous and helpful.

Completely Disagree

Somewhat Disagree

Neither Agree nor Disagree / Neutral / N/A

Somewhat Agree

Completely Agree

My midwives were good about explaining the logistics around meeting at the Center for Birth birth center when in labor.

My midwives were good about explaining where to park at the Center for Birth birth center.

The birth suite was comfortable.

The birth center seemed well equipped.

I was satisfied with the birth center.

I am dissatisfied with some things about the care I received (explain below).

My midwives were good about explaining how to register at the Center for Birth birth center.

If I had any contact with Center for Birth staff, they were courteous and helpful.

Clear selection

Comments

How did you hear about Center for Birth?

Online Search

Paper-based advertisement

Word-of-mouth from friend

Recommendation from midwife

Referral or recommendation from doctor

I have been a client at the birth center before

Other:

Clear selection

Did you transfer to midwifery care and a birth center birth after initially planning a hospital birth?

Yes

Clear selection

Did you switch to a birth center birth after initially planning a home birth?

Yes

Clear selection

I chose Center for Birth because (choose all that apply):

It was close to home

It was close to the hospital

I liked the building/atmosphere/birth center spaces

My insurance covered most of the cost

My preferred midwives deliver there

Other:

What do you feel our strong points are?

What do we most need to improve?

Do you have specific suggestions for improved or expanded services?

Would you recommend us to friends and family?

Yes

Maybe

Clear selection

What influenced your decision to choose a birth center for your labor and delivery?

Is there anything else you would like to add regarding your experience at Center for Birth?

May we use quotations from your comments?

Yes

Clear selection

If yes, how may we attribute them? (please write your name as you would like it to appear, or indicate "anonymous")

Any additional comments:

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