Dear Parent,

We invite your feedback about your recently completed HypnoBirthing® course. Your responses will greatly improve future planning and course improvements. It will also contribute to your practitioner's certification renewal.

This is a secure website and all responses are encrypted for transmission over the internet in order to protect your privacy. You can rest assured that your response will only be used by HypnoBirthing® Institute administrators, and not shared with anyone else.

It will only take a few minutes to complete the survey. We greatly appreciate your time and input.

* HypnoBirthing® practitioner's name

* Approximate date classes began

Please enter

* Was this a private or group course?

* Amount you paid for the course

* Did you you attempt to get any sort of insurance or health account reimbursement for the HypnoBirthing course?

* HypnoBirthing course materials include the HypnoBirthing book, the Rainbow Relaxation CD, and a number of class handouts. (NOTE: The Rainbow Relaxation is NOT the CD that comes bound into the US edition of the book.)

Please note how you obtained these.

* Course format

  1 2 3 4 5 6 or more
How many times did this course meet?

* How long was each session?

* About how many weeks pregnant were you when the course began?

* PRIOR TO taking this course, how did you feel about your ability to have a peaceful, gentle, more comfortable birth:

* How useful did you find the following course materials, exercises and demonstrations in helping you to prepare for birthing?

  Helpful/useful Confusing Understandable but not useful Not part of the course
The HypnoBirthing book
The "HypnoBirthing Birth Stories" video
Other birthing videos
"What Babies Want" video
HypnoBirthing breathing techniques
Relaxation, visualization and deepening techniques
Light Touch Massage
Postures/exercises to help baby into the best position for birthing
Class handouts

* Please indicate to what degree you agree or disagree with the following statements:

  Strongly Agree Agree Neither agree nor disagree Disagree Strongly Disagree
The practitioner was prepared for class
The practitioner was very knowledgeable
The practitioner's manner was positive and inspiring
The course material was clear and comprehensive
The pace of the material presented in class was appropriate
The practitioner adequately answered questions during class
The practitioner's overall teaching style was effective
The learning environment was comfortable
I believe the practitioner will be available if I have questions or concerns
The course improved my understanding of normal birthing
The course helped me to understand my birthing options
I will recommend the HypnoBirthing course to others
I will recommend this practitioner to others

* AFTER taking this course, how do you feel about your ability to have a peaceful, gentle, more comfortable birth:

* Please use the space below to comment on the aspects of the course that you enjoyed and have helped you learn.

* Please use the space below for suggestions for improving any aspect of the course, or noting things you did not find helpful.

* May we contact you for quality assurance purposes? All contact information will remain confidential and will not be shared with your practitioner or with anyone outside the administrative offices of the HypnoBirthing® Institute without your specific permission.

* If you agree to be contacted, please enter your email address:

Thank you very much for your time. We offer our warm wishes for a wonderful, gentle birthing. Shortly after your baby is expected, we will send you a Birth Report survey. Your responses will be completely confidential.

Your responses will be saved when you leave this website.