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VA PEP Parent Survey
1.
Name of the hospital where you gave birth
2.
Name
3.
Phone number (in case you win the drawing)
4.
Did you establish paternity at the hospital?
Yes
No
5.
If no, why did you not establish paternity?
Father not present at the hospital
Father lack ID
Mother lacks ID
Mother choices not to identify father
Hospital staff did not discuss or offer to complete the AOP form
Parents would like genetic test
Mom is married to someone other than biological father
Father deployed
Other (please specify)
6.
Did the hospital present information in a clear respectful manner?
Yes
No
Any details you would like to share?
Current Progress,
0 of 6 answered
