1. Patient Satisfaction Survey "Birthing Services"

When you complete this form, you will help our staff see themselves through your eyes. We need your criticism and suggestions as well as your praise Thank you for your honest responses.

* 2. How did you first hear about WBWC?

* 3. What was your main reason for choosing to come to the Birth Center?

* 4. Please rate our staff on competency, attitudes, and sensitivity to your needs (comments welcome):

  Excellent Good Adequate Needs Improvement N/A
Providers (FNP, CNMs)
Nurses (RNs)
Administration/ Clerical

* 5. My baby was born at

* 6. The CNM and RN attending my birth were

* 7. Rate your experience for/ your impression of the following services:

  Excellent Good Adequate Needs Improvement N/A
Availability of Appointments
Telephone Answering
Orientation Tour
Initial Visit
Prenatal Care
Lab Work
Supportive Environment
Family Inclusiveness
Opportunity to participate in decison making
Sufficient Explanations & Teaching
Breastfeeding information & Support
Postpartum Care & Support after leaving Center
Emergency Equipment
Transfer to UNC (if applicable)
Physical facilities

* 8. What suggestions do you have to improve our services?

* 9. Would you recommend the Birth Center to your friends?

  1) Not Likely At All 2) 3) 4) 5) 6) 7) 8) 9) 10) Extremely Likely
On a 10pt. Scale

* 10. What would you like to have happen differently at your next birth should you decide to have another baby? Any final comments please note below as well.