Doula Client Survey

Impact-Site-Verification: d4759ae8-3d7c-4a00-9e6f-c9a61fbc4c0a

It has been an honor and pleasure supporting you. Thank you for welcoming me and trusting me to care for you and your family. I would greatly appreciate your feedback in completing this survey regarding my support as your doula.

NOTE: Survey responses may be used in Atala Doula Services social media and/or marketing materials unless you specifically communicate you do not consent to the use of your responses for this purpose.

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Name *

Email *

Evaluation of Services

For each statement in this section, select the option that most closely matches your experience.

Our prenatal appointments were useful and informative. *5 – Strongly Agree4 – Agree3 – Neutral2 – Disagree1 – Strongly DisagreeN/A

My doula provided me with helpful emotional support during pregnancy and birth. *5 – Strongly Agree4 – Agree3 – Neutral2 – Disagree1 – Strongly DisagreeN/A

My doula provided me with helpful informational support during pregnancy and birth. *5 – Strongly Agree4 – Agree3 – Neutral2 – Disagree1 – Strongly DisagreeN/A

My doula provided me with helpful physical/practical support during pregnancy and birth. *5 – Strongly Agree4 – Agree3 – Neutral2 – Disagree1 – Strongly DisagreeN/A

My doula contributed to me having a positive birth experience. *5 – Strongly Agree4 – Agree3 – Neutral2 – Disagree1 – Strongly DisagreeN/A

My doula provided me with helpful emotional support postpartum. *5 – Strongly Agree4 – Agree3 – Neutral2 – Disagree1 – Strongly DisagreeN/A

My doula provided me with helpful informational support postpartum. *5 – Strongly Agree4 – Agree3 – Neutral2 – Disagree1 – Strongly DisagreeN/A

My doula provided me with helpful physical/practical support postpartum. *5 – Strongly Agree4 – Agree3 – Neutral2 – Disagree1 – Strongly DisagreeN/A

My doula contributed to me having a positive postpartum experience. *5 – Strongly Agree4 – Agree3 – Neutral2 – Disagree1 – Strongly DisagreeN/A

Feedback Questions

For each question in this section, please provide your feedback.

What services or support were most helpful for you? *

What stood out to you about the support your doula provided? *

What were some of the biggest challenges you anticipated about your birth and/or postpartum time? *

How do you feel about those challenges as our time comes to a close and you move forward in your new life? *

Is there anything that you feel would have improved our time together?

Future Communication Preferences

My doula is welcome to check in monthly via text/email starting at 4 months postpartum through 1 year postpartum. *

• Yes
• No
• Less frequently, please
• More frequently, please

My doula is welcome to check in semi-annually via text/email starting at 1 year postpartum through 3 years postpartum. *

• Yes
• No
• Less frequently, please
• More frequently, please

Preferred method of communication for check-ins?

• Text
• Email
• Phone call
• Video call

I welcome a card from my doula in recognition of my baby's birthday. *

• Yes
• No
• Prefer another form of recognition instead of a card

If you have any specific requests regarding future communications, feel free to share here.

Additional Comments

If you have any other feedback, feel free to share here.

How would you rate your overall experience?

Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5

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