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Maternal and Child Health Service Feedback
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1.
Which maternal and child health service did you attend?
(Required.)
Churchill
Glengarry
Moe Service Centre
Moe Heights (Prince Street)
Morwell
Newborough
Traralgon
Yallourn North
Yinnar
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2.
Was it quick and easy to make an appointment using the maternal and child health central booking number?
(Required.)
Yes
Somewhat
No
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3.
Was your maternal and child health service appointment:
(Required.)
On time
Up to 5 minutes late
Up to 10 minutes late
Up to 20 minutes late
Over 20 minutes late
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4.
Was your maternal and child health nurse sensitive and supportive to your needs and did you feel you could openly discuss concerns?
(Required.)
Yes
Somewhat
No
Comments
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5.
Overall how satisfied are you with the maternal and child health service you received?
(Required.)
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
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6.
What date did you attend you Maternal and Child Health appointment?
(Required.)
Date
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
7.
Do you have any other comments, questions, or concerns?
8.
Would like to be contacted about your feedback?
If yes, what is your name and phone number?
9.
Have you seen the Maternal and Child Health program promoted on Facebook?
Yes
No
