Labour Doula Evaluation Form

Before you begin, I would like to take this moment to thank you for allowing me to work with your family. It was such an honour to support you.

For the evaluation, I would appreciate your complete honesty.   Your feedback will be used to help me to develop my services, learn from my experiences, and better assist future clients.

Client's Name *
Client's Name
Partner's Name
Partner's Name
if applicable
Phone *
Phone
Date of baby's birth *
Date of baby's birth
Are you comfortable with Doula Canada contacting you if they have any questions? *
Prenatal Support
Were you satisfied with the number of prenatal visits that you received? *
Did the length of our visits seem: *
Was the prenatal support you received consistent and reliable? *
Was I easy to contact when you needed? *
Did you feel comfortable asking questions or making requests of me? *
Do you feel I included both partners equally and considered each partner’s concerns effectively?
if applicable
Labour Assistance
Was I easy to contact once you were in labour? *
Did I arrive in a timely fashion once you requested my presence? *
Did I arrive in a professional manner with the tools/aids we discussed? *
Was the support consistent and reliable during labour? *
Do you feel I made it possible for you to make informed decisions? *
Do you feel I supported the decisions you made without judgment or criticism? *
Did you feel comfortable asking questions or making requests of me? *
Did I work to ensure the partner was included in the process to the extent he/she was comfortable? *
if applicable
Immediately following birth, do you feel my support to the mother/birthing person was consistent and reliable? *
Did I stay for an appropriate amount of time following birth? *
Was the support consistent and reliable in the period of time after delivery until I departed? *
Postpartum Support/Visits
Did I follow up with you via phone in a sufficient time frame? *
Was your first home visit made within a satisfactory amount of time after your delivery? *
Were your postpartum concerns addressed and referrals made when necessary? *
Other
Were the terms of your contract honoured and followed as discussed? *
Would you consider writing a testimonial of your experience that I can use when prospecting future clients? *

Thank you again for your time!