Survey-OLD

We would like to ask you to evaluate the care you received while working with us as your midwives. Your candid response will help us to improve the care we provide to women and their families in the future. Thank you.

How did you hear about us? *

Internet Search Advertisement Friend Other

How would your describe the atmosphere at Around the Circle Midwifery? *

My partner, children and friends were *

welcomed and included felt unwelcome not applicable

Was it easy to establish a comfortable rapport with the staff? *

Yes Somewhat No

Do you feel that your thoughts and opinions were respected? *

Always Sometimes Rarely Never

Referrals to other providers and services were *

made as needed not made when needed not needed

Were you comfortable with the Student Midwife? *

Yes No Not applicable

Did you understand the role of the Birth Assistant in your care? *

Yes No Not applicable

I would recommend my midwives without hesitation to a good friend. *

Thank you for your time. Call or email us directly if you would like to discuss your care further. Please remember The Midwives Association of Washington State provides Quality Assurance and Improvement programs for Licensed Midwives in their membership and will review any complaints regarding midwifery care provided by their members.

Dear friends,