Gift of Motherhood Evaluation Form

In this Section

 Mom-to-be    Support person
    
    

This form is secure. To protect your privacy, we have made every effort to protect this email from being accessed and viewed by other Internet users, without your knowledge and permission, while in transit to us. The recipient of your responses will not be able to view your contact information unless you choose to provide it in one of the fields below.


Rank 1-5.   1 Being Very easy, 5 being Very difficult 1 2 3 4 5
1a How easy was it to register for this class? (If not, please describe in Question 7.)
b How convenient was it for the mom-to-be to take this class compared to attending classes?
c How convenient was it for the support person(s) to take the class compared to attending classes?

Rank 1-5.   1 Being Very, 5 being Not at all 1 2 3 4 5
2a How helpful did you feel the information in the right hand tabs was to you?
b How helpful did you feel the information in the purple buttons at the bottom was to you?
c How easy was it to find the answers to your questions using the online class in combination with the book you received from our doctor or clinic?

Rank 1-5.   1 Being A lot, 5 being Not at all 1 2 3 4 5
3a Did this class help you identify questions you may want to discuss with your medical caregiver(s)?
b Did this class help you identify preferences you wanted to have for your birth?
c After this class, how how confident were you about giving birth?


How much did you do the following in the last few weeks of pregnancy? Please note: 4-5x/wk=a lot 4-5x/wk 2-3x/wk 1x/wk None
4a Read book sections listed on "Things to Do Before You Have Your Baby"?
b Practice breathing/relaxation?
c Practice comfort measures together?
d Use the Feedback Process when you practiced together?

Yes No
e Did you enjoy practicing or find it helpful to you?

5 What did you like most about our online learning?  
6 What did you like least about our online learning?  
7 What suggestions do you have for improving our online learning?  
  
 

Columbia St. Mary's

Site Map | Disclaimer | Privacy Policy | Non-Discrimination Statement
Copyright © 2018 Columbia St. Mary's | Milwaukee, WI
Connect Healthcare CMS Solutions