Name

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First Name

Last Name

How would you rate the overall communication with the staff during your prenatal care?

Very Poor

Poor

Okay

Good

Excellent

Did you feel that your concerns and questions were adequately addressed?

No

Sometimes

Yes

How timely were the responses to your inquiries?

Not timely at all

Not timely most of the time

Timely most of the time

Always timely

How would you rate the clarity of the information provided to you about your prenatal care options?

Not clear at all

Not clear sometimes

Clear most of the time

Always clear

If the information was not clear, was the staff member able to clarify the information?

No

Sometimes

Yes

Did you feel that you had sufficient opportunity to communicate your preferences and decisions at appointments?

Never

Some appointments

Every appointment

How clear was the educational information provided during prenatal education sessions?

Not clear at all

Not clear sometimes

Clear most of the time

Always clear

If the educational information was not clear, was the staff member able to clarify the information?

No

Sometimes

Yes

Were the educational materials provided helpful in understanding prenatal care?

No

Sometimes

Yes

Did you feel prepared for the different stages of your pregnancy based on the education provided?

Not prepared at all

Somewhat prepared

Very prepared

How would you rate the competence of the staff involved in your prenatal care?

Very poor

Poor

Okay

Good

Excellent

Did the staff exhibit a thorough understanding of prenatal care practices?

Not at all

Some of the the time

Most of the time

All of the time

Did you feel comfortable with the staff?

Never

Some of the time

With one of the providers

With some of the providers

With all except one provider

With all of the providers

Would you recommend the Birth Center to others?

Yes

No

Maybe