3rd Annual Veteran & Service Member Women Regional Community Baby Shower

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1. Name (Required.)

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2. Email (Required.)

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3. Phone (optional)

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4. Where do you receive your Primary Care

Central Western Mass

Bedford

Providence

Other VISN 1 (new England) site

MTF (Military Treatment Facility)

Community Care Provider (using a civilian provider with insurance )

I don't have a primary care anywhere

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5. What option best describes your Service Member or Veteran status

Reserve- TPU (Reserve drilling member once a month )

National Guard- M-DAY (Drilling National Guard member once a month)

Active Duty

AGR- NG (National Guard Active Duty- Continuous)

AGR- Reserve (Reserve Active Duty- Continuous)

Veteran- Enrolled in VHA (using Veterans Health Administration)

Veteran- Un-Enrolled in VHA

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6. Please select your branch of service

Army

Navy

Air Force

USMC

Coast Guard

Space Force

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7. Where are you in your pregnancy journey? (All are welcome, we just want to know for content development)

Just starting to try (naturally or with fertility assistance)

Currently pregnant

I have delivered or am expecting to deliver by the shower

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8. What information related to your pregnancy journey would be most important for you to receive?

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9. What best describes how you found out about this event?

I was called because I was already enrolled in VHA Maternity Care

I saw it on social media- not VA directly advertising

I saw this on a closed group for Veterans or Service Members

I saw this on a community page

I was following another organization and they shared the event

I was told about the event by a friend or battle buddy

I found out about it from my unit/unit support- Command team, Wellness team, Chaplin, etc

Other (please specify)

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10. Will anyone else be attending with you?

Yes

If so, please specify who? Partner, child, other family member i.e. mother, sister

3rd Annual Veteran & Service Member Women Regional Community Baby Shower

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* 1. Name (Required.)

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* 2. Email (Required.)

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* 3. Phone (optional)

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* 4. Where do you receive your Primary Care

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* 5. What option best describes your Service Member or Veteran status

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* 6. Please select your branch of service

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* 7. Where are you in your pregnancy journey? (All are welcome, we just want to know for content development)

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* 8. What information related to your pregnancy journey would be most important for you to receive?

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* 9. What best describes how you found out about this event?

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* 10. Will anyone else be attending with you?

1. Name (Required.)

2. Email (Required.)

3. Phone (optional)

4. Where do you receive your Primary Care

5. What option best describes your Service Member or Veteran status

6. Please select your branch of service

7. Where are you in your pregnancy journey? (All are welcome, we just want to know for content development)

8. What information related to your pregnancy journey would be most important for you to receive?

9. What best describes how you found out about this event?

10. Will anyone else be attending with you?