Blossom Birth Yoga Evaluation 2014

1. Demographic Info

Please take a few moments to let us know how we are doing! Your input is invaluable as we learn how to better meet your needs and those of the greater community. This survey is meant for our students of Prenatal Yoga, Couples Prenatal Yoga, Mom & Baby Yoga, and Mom & Toddler Yoga classes.

Question Title

* 1. In which city do you live?

Question Title

* 2. What is the name of your OB/GYN or Midwife?

Question Title

* 3. What is the name of your child's Pediatrician?

Question Title

* 4. Are you currently:

Currently expecting for the first time

New Parent (baby less than one year old)

Parent of child(ren) older than one year (not currently expecting)

Currently expecting for a second or subsequent time

Other

Question Title

* 5. How did you hear about Blossom Birth's Yoga classes? (Please check all that apply.)

In another Blossom Class

Blossom Staff

Walk By

Websearch

Friend

Provider (OB, doula etc)

Other (please specify)

Question Title

* 6. Did you practice Yoga before your pregnancy?

Yes

Question Title

* 7. How many years have you been practicing Yoga (in total, not limited to prenatal or postpartum yoga)?

Less than 2 years

Between 2-4 years

Over 4 years

Question Title

* 8. How would you rate your Yoga skill level?

Beginner

Intermediate

Advanced

Question Title

* 9. Please rate the following in importance of what you seek in a yoga class :

	Extremely important	Important	Somewhat Important	Unimportant
Physical exercise- for strengthening	Physical exercise- for strengthening Extremely important	Physical exercise- for strengthening Important	Physical exercise- for strengthening Somewhat Important	Physical exercise- for strengthening Unimportant
Physical exercise- for stretching	Physical exercise- for stretching Extremely important	Physical exercise- for stretching Important	Physical exercise- for stretching Somewhat Important	Physical exercise- for stretching Unimportant
Pain relief/ comfort measures during pregnancy/ postpartum	Pain relief/ comfort measures during pregnancy/ postpartum Extremely important	Pain relief/ comfort measures during pregnancy/ postpartum Important	Pain relief/ comfort measures during pregnancy/ postpartum Somewhat Important	Pain relief/ comfort measures during pregnancy/ postpartum Unimportant
Asana (posture) practice	Asana (posture) practice Extremely important	Asana (posture) practice Important	Asana (posture) practice Somewhat Important	Asana (posture) practice Unimportant
Meditation	Meditation Extremely important	Meditation Important	Meditation Somewhat Important	Meditation Unimportant
Relaxation	Relaxation Extremely important	Relaxation Important	Relaxation Somewhat Important	Relaxation Unimportant
Sharing/ Discussion	Sharing/ Discussion Extremely important	Sharing/ Discussion Important	Sharing/ Discussion Somewhat Important	Sharing/ Discussion Unimportant
Meeting other moms/moms-to-be	Meeting other moms/moms-to-be Extremely important	Meeting other moms/moms-to-be Important	Meeting other moms/moms-to-be Somewhat Important	Meeting other moms/moms-to-be Unimportant
Prenatal: Education (learning about birth options, pain coping techniques)	Prenatal: Education (learning about birth options, pain coping techniques) Extremely important	Prenatal: Education (learning about birth options, pain coping techniques) Important	Prenatal: Education (learning about birth options, pain coping techniques) Somewhat Important	Prenatal: Education (learning about birth options, pain coping techniques) Unimportant
Prenatal: Comfort in pregnancy (relieving back pain, etc.)	Prenatal: Comfort in pregnancy (relieving back pain, etc.) Extremely important	Prenatal: Comfort in pregnancy (relieving back pain, etc.) Important	Prenatal: Comfort in pregnancy (relieving back pain, etc.) Somewhat Important	Prenatal: Comfort in pregnancy (relieving back pain, etc.) Unimportant
Postpartum: Doing something fun with my baby	Postpartum: Doing something fun with my baby Extremely important	Postpartum: Doing something fun with my baby Important	Postpartum: Doing something fun with my baby Somewhat Important	Postpartum: Doing something fun with my baby Unimportant
Postpartum: Getting back “in shape” after birth	Postpartum: Getting back “in shape” after birth Extremely important	Postpartum: Getting back “in shape” after birth Important	Postpartum: Getting back “in shape” after birth Somewhat Important	Postpartum: Getting back “in shape” after birth Unimportant

Other (please specify)