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* 1. Your name (optional, but appreciated)

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* 2. Please indicate which response most closely matches your opinion.

  Completely Disagree Somewhat Disagree Neither Agree nor Disagree / Neutral / N/A Somewhat Agree Completely Agree
My midwives were good about explaining the reason for medical tests and procedures.
The office space was comfortable and seemed to be well equipped.
The midwifery care I received was just about perfect.
Sometimes I questioned my midwife's diagnosis or judgment (explain below).
Whenever I had a specific concern, the midwife was careful to examine me or discuss with me.
My midwives acted too businesslike and impersonal toward me.
My midwives acted in a friendly and courteous manner toward me.
My midwives sometimes ignored my concerns.
The time my midwives spent with me during appointments was adequate.
Scheduling an appointment was not easy and convenient.
I am dissatisfied with some things about the care I received (explain below).
My midwives were good about explaining logistics around meeting at the Center for Birth birth center when in labor.
My midwives were good about explaining where to park at the Center for Birth birth center.
If I had any contact with Center for Birth and/or Center for Birth Midwives staff, they were courteous and helpful.
I was generally satisfied with the birth center.
The birth suite was comfortable.
The birth suite was spacious enough.
The birth center seemed well equipped.
I was satisfied with the cleanliness of the birth suite.

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* 3. How did you hear about Center for Birth and/or Center for Birth Midwives? (select all that apply)

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* 4. I chose Center for Birth Midwives because:

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* 5. Did you transfer to a birth center birth after initially planning a hospital birth and/or a home birth?

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* 6. I chose Center for Birth because (choose all that apply):

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* 7. Is there anything else you would like to add regarding your experience at Center for Birth or Center for Birth Midwives?

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* 8. May we use quotations from your comments?

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* 9. If yes, how may we attribute them? (please write your name as you would like it to appear, or indicate "anonymous")

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* 10. Any additional comments:

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