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Heart of Houston Birth & Wellness Center

Client Satisfaction Questionnaire

Please take some time to provide us with your evaluation of the midwifery care that you received during your recent pregnancy, birth and postpartum period. You do not need to identify yourself unless you would prefer to do so. Your comments will be reviewed by our practice and can help us evaluate and improve the quality of care we provide to our clients.

General Information

Was this your first time in midwifery care?
Would you recommend our care to a friend?
Did midwifery care meet your expectations?

Prenatal Care

Were there enough opportunities for you to meet the midwives involved in your care?
In general, were your choices and decisions supported by your midwife?
Frequency and length of your prenatal visits
Good
Fair
Poor
How welcome your partner or support people felt
N/a
Good
Fair
Poor
Usefulness of information provided for decision making
Good
Fair
Poor
How comfortable you felt asking questions
Good
Fair
Poor
Consistency of information provided by your midwives
Good
Fair
Poor
Your overall satisfaction with your pregnancy care
Good
Fair
Poor

Labor and Birth

Where were you planning to give birth?
Where did you actually give birth?
The support provided to you in labor by your midwife
NA
Good
Fair
Poor
Care provided by the birth assistant
NA
Good
Fair
Poor
The clarity and amount of information provided to you about your progress in labor
NA
Good
Fair
Poor
Usefulness of information provided for decision making
NA
Good
Fair
Poor
How much you felt like an active participant in decision making
NA
Good
Fair
Poor
Consistency of information provided by care providers
NA
Good
Fair
Poor
Overall care during your labor and birth
NA
Good
Fair
Poor

If you had a hospital birth:

Care provided by hospital staff, such as doctors/midwives & nurses
NA
Good
Fair
Poor
Your overall satisfaction with having a hospital birth
N/A
Good
Fair
Poor

Postpartum Care

The number, frequency, and length of postpartum visits
N/A
Good
Fair
Poor
Breastfeeding support provided
N/A
Good
Fair
Poor
Emotional support provided
N/A
Good
Fair
Poor
How comfortable you felt calling with questions or concerns
N/A
Good
Fair
Poor
Consistency of information provided by your midwives
N/A
Good
Fair
Poor
Your overall satisfaction with your postpartum care
N/A
Good
Fair
Poor

Student Involvement

If you had a student involved with your care, please complete the following section.

Your understanding of the scope of the student’s role in the practice
N/A
Good
Fair
Poor
The supervision of the student by the midwives
N/A
Good
Fair
Poor
Your overall satisfaction with the student’s involvement in prenatal care
N/A
Good
Fair
Poor
Your overall satisfaction with the student’s involvement in birth
N/A
Good
Fair
Poor
Your overall satisfaction with the student’s involvement in postpartum care
N/A
Good
Fair
Poor

Please add any additional comments, feedback or suggestions:

Client Satisfaction Survey

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