Puget Sound Birth Center Client Feedback Form

It is our intention to hold ourselves to the highest standard of midwifery care possible such that we may promote satisfying and safe experiences for our clients. To that end, the midwives at the Puget Sound Birth Center routinely participate in continuing education, liability review, and state-sanctioned peer & incident review through our professional association. This reflects our dedication to a process of continued learning, self-evaluation and accountability that requires your participation as well. In order to best serve you and the clients yet to come we hope that you will invest your feedback in us. Thank you!

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* Who are your midwives?

Eastside Midwives (Courtney Smith, Amanda Ferre)

Lake Washington Midwives (Ali Tromblay, Blake Stewart, Heather Stewart)

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* Approximately when did you last receive care at PSBC?

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* How satisfied are you with...

	Not at all	Met expectations	Exceeded expectations	N/A
Our facility?	Our facility? Not at all	Our facility? Met expectations	Our facility? Exceeded expectations	Our facility? N/A

Comments

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* How satisfied are you with...

	Not at all	Met expectations	Exceeded expectations	N/A
Our staff?	Our staff? Not at all	Our staff? Met expectations	Our staff? Exceeded expectations	Our staff? N/A
Our students?	Our students? Not at all	Our students? Met expectations	Our students? Exceeded expectations	Our students? N/A
Our accessibility and communication?	Our accessibility and communication? Not at all	Our accessibility and communication? Met expectations	Our accessibility and communication? Exceeded expectations	Our accessibility and communication? N/A

Comments

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* How satisfied are you with...

	Not at all	Met expectations	Exceeded expectations	N/A
Your prenatal care?	Your prenatal care? Not at all	Your prenatal care? Met expectations	Your prenatal care? Exceeded expectations	Your prenatal care? N/A
Your care during labor and birth?	Your care during labor and birth? Not at all	Your care during labor and birth? Met expectations	Your care during labor and birth? Exceeded expectations	Your care during labor and birth? N/A
Your postpartum care?	Your postpartum care? Not at all	Your postpartum care? Met expectations	Your postpartum care? Exceeded expectations	Your postpartum care? N/A

Comments

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* What do you feel our strong points are?

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* What do we most need to improve?

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* Do you have specific suggestions for improved or expanded services?

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* Did you use the messaging system in your client portal

Yes

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* If you used your client portal messaging, did you find it easy to use?

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* Would you recommend us to friends and family?

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* May we add your comments to our website?

Sure!

No thanks

Please contact the Birth Center Manager with any questions or concerns micki@birthcenter.com or 425-823-1919

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* Would you attend a drop in class if offered at your PSBC?

Yes

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* If yes, what type of class would you like to attend?

Lactation support

Baby wearing (how to choose a carrier & how to best use what you have)

Listening mothers support

Partner support group

Preparing to return to work

Other (please specify)

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* How much would you be willing to pay for a drop-in class?

Needs to be free

$5.00 per class

$10.00 per class

Whatever the facilitator would need to charge

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* Thank you so much for taking the time to complete this survey.

Name (Optional)

Best Contact (Optional)