Client Evaluation Survey

* Indicates required field

Name *

First

Last

Email *

Year & Month of Final Visit *

What is your age? *

How did you hear about Access Midwives? *

What factors influenced you to choose midwifery care? Check all that apply. *

Extra Support Continuity Of Care Assistance With Breastfeeding Other

Was this your first birth? *

Yes No

Was this your first birth with a midwife? *

How Happy Are You With The Number Of Prenatal Visits You Received? *

Excellent Good Fair Poor

How Happy Are You With The Length Of Your Prenatal Visits *

Excellent Good Fair Poor

How Convenient Was Scheduling Your Appointments? *

Excellent Good Fair Poor

Did You Feel Properly Prepared & Educated By Your Midwives? *

Yes No

Midwives must ensure that clients have no more than four midwives involved in their care, and that there is 24 hour on-call access through pregnancy, labour and postpartum.

How Satisfied Were You With The Overall Continuity Of Care You Received? *

Excellent Good Fair Poor

If Your Birth Required Medical Intervention or Transfer, How Satisfied Are You With This Process? *

Excellent Good Fair Poor

How Would You Rate Your Overall Prenatal Care? *

Excellent Good Fair Poor

How Satisfied Were You With The Overall Care During Labour & Delivery *

Excellent Good Fair Poor

Informed Choice: Midwives must provide clients with information about their education and expertise, how midwives practice in Ontario, and what standards and protocols they must follow. Throughout care, midwives must provide clients with enough information to make informed decisions about their care.

Consultation and Transfer of Care: Midwives are required to consult with physicians for consult with physicians for certain conditions that may arise during pregnancy, labour, and post partum. Some conditions require that a physician take over care.

Would You Like To Be Contacted By Our Staff? *

Yes No

How Satisfied Are You With Your Midwives As It Pertains To Informed Choice? Did You Feel Fully Respected In Your Journey? *

Excellent Good Fair Poor

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He will cover you with His feathers, and under His wings you will find refuge; His faithfulness will be your shield and rampart. -Psalms 91:4

What Our Clients Are Saying:

“Having you for midwives has been a divine intervention in
our lives. You are some of the most caring and loving
people we have ever met. This entire journey has been
wonderful and we thank you for always being there to help
us! This birth was perfect and there is no one I could
trust more.” Mariann

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