Let's Get to Know You...

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* 1. Are you...

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* 2. Where have you received services for prenatal care? Check all that apply.

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* 3. Where have you experienced or observed birth? Check all that apply.

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* 4. How do you self-identify? This can be a cultural, religious, ethnic, or other identity that defines how you are perceived by the world around you.

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* 5. Do you have health insurance that would pay for maternity care? Is so, what kind?

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