MI-Home Satisfaction Survey

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You are receiving this survey as you have received one or more appointments during 2020-2021 with the Midwifery Integrated Home Visitation Program, also known as MI-Home. Le'a Minton is the midwife and lactation consultant, Dr. Men-Jean Lee and Dr. Lisa Bartholomew are the maternal-fetal medicine physicians, and staff you may have interacted with include Jenaiah Banasihan. We appreciate any feedback you have to share regarding your experience with the MI-Home program. This survey is 100% anonymous.

Which health services have you received from us? (select all that apply) *

Prenatal

Non-stress Test (20 minutes listening to baby's heart beat)

Postpartum

Lactation Support

Blood Pressure Check

Family Planning Services: planning or preventing a pregnancy

LARC insertion (IUD or implant)

LARC removal (IUD or implant)

STI/STD screening and/or treatment

Well Woman

Newborn Care <29 days

Prescription Refills

Diabetes Management

Substance Use Management

Referral to medical care

Other:

Required

Please select all support services that we assisted you with: *

Health Insurance Application

SNAP (food)

WIC (food)

TANF (financial)

Housing

Temporary Shelter

Transportation (Bus Pass, Lyft or Medicaid Provided)

Identification

Behavioral Health Referral

Case Management Services (through MI-Home)

Psychiatric evaluation

General Education Development (GED)

Government Phone Assistance Program

Parenting Classes

Service Coordination (through health insurance plan)

Social Security/ Disability

None

Other:

Required

How would you rate your experience with the MI-Home Program? *

Poor Experience

Excellent Experience

What was the most beneficial part of the program for you? *

What could we have done better to improve your experience? *

If MI-Home were not available, what would you have done to access health care and social services? *

How likely are you to recommend MI-Home to others? *

Not At All likely

Extremely Likely

If you are no longer receiving services from MI-Home, please select any of the following that applies to you: *

Services no longer needed

One-Time visit

Transfer of care to new OB provider

Relocation to other country/ state/ inter island

None of the above; current MI-Home client

Other:

Required

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