About You

This survey is in relation to postpartum resources and experiences. If you have not given birth, this survey will not apply to you.

Thank you for responding to this listening survey. The information you provide will help your local health organizations design programs to help families stay healthy before, during, and after pregnancy. 

This survey asks for some information about you. We will combine the information from all the people who participate in this survey to understand their collective background. You can skip any questions that you do not want to answer.

If you complete the survey, you will be eligible to enter a drawing to receive a gift card. Your information will only be used to give you the gift card and will be disposed of after the survey has been closed and the gift cards are sent out to winners. 

Question Title

* 1. How old are you?

Question Title

* 2. What is the highest level of education you have completed?

Question Title

* 3. How do you describe yourself? (select one or more answers)

Question Title

* 4. Do you identify as Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, or Asexual, etc.?

Question Title

* 5. How many children do you have?

Question Title

* 6. How many adults and children are living in your home right now?

Question Title

* 7. What is your zip code?

T