Satisfaction Survey

please type todays date
please type in your First and Last name

My Primary Case Manager...

 Was helpful with things important to me?
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 Met or talked with me when I needed help?
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Made me feel like I am able to take care of myself and my baby?
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Kept my business private?
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Gave me information I needed?
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Involved me in developing a plan to reach my goals?
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Spent enough time with me?
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Treated with me respect?
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While in this program...

Prior to this pregnancy, were you familiar with CHHS services?

Do you feel you got what you expected from this program?

If you have another baby in the future would you use CHHS services again?


I have a few questions about your pregnancy experience

In general, how would you say your overall experience was with your pregnancy?




These next questions ask you about things during your pregnancy

Did the doctor, nurse, or midwife tell you about the Healthy Start Program for pregnant women and babies?

It was easy making an appointment to see the doctor or midwife.





The length of time I spend in the waiting room is too long.





The office staff at the doctor's or midwife's office always treated me with courtesy and respect.





your baby's birth date

These next questions ask you about things during your labor and delivery.

Did anyone help you find a health care provider for new baby?


Thinking about your labor and delivery care, overall would you say your experience was?



Thinking about your labor and delivery care, overall would you say your experience was:


Did you have a Doula with you during your labor and delivery?