Postpartum Survey
Thank you for allowing me to be a part of your labor, please fill this out, it will help me to get better and better.
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By filling out this form you are also giving permission to use your answers in publications including but not limited to social media platforms. No personal identifiable information would be included. Thank you again!
Primary Doula’s Name *
Partner or Shadowing Doula’s Name (if relevant)
Date of Delivery *
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DD
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What is your estimated income? *
What type of support did you receive? *
Required
Did you feel your doula performed well for you during your birth? *
Do you feel that your birth experience was enhanced by the presence of a doula? *
What are some suggestions for your doula? *
What are some comments you have for your shadowing doula?
Would you have a doula again?
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Would you have YOUR doula again?
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What is the most memorable part of your doula experience as it impacted your birth experience?
Do you have feedback for your birth location or medical care provider that you would like us to pass along?
If yes, please name your birth location, medical provider (or nurses) and write your comments below.
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