PROGRAM EVALUATION

Thank you for working with Everyday Miracles! We would greatly appreciate your honest feedback about your experience with our program and our doulas. Sharing your experiences helps us to improve our programs. Thank you for taking the time!

Birthing Parent's Name *
Birthing Parent's Name
Baby's Date of Birth *
Baby's Date of Birth
If you worked with multiple doulas (for back-up or other reasons) please include all doulas you worked with
How would you rate your overall experience with the Everyday Miracles?
Physical Support *
The techniques suggested by the doula were helpful to the birthing person in handling the physical aspects of labor. Please use this guide to rate your experience: 1 = More harm than good 3= Neutral 5= Was a big help
Emotional Support *
The techniques used by the doula were helpful to the birthing person in handling the emotional aspects of labor. Please use this guide to rate your experience: 1 = More harm than good 3= Neutral 5= Was a big help
Additional Support *
The suggestions of the doula were helpful for the partner and/or family members and friends present for the labor. Please use this guide to rate your experience: 1 = More harm than good 3= Neutral 5= Was a big help
Overall Support *
Overall, how would you evaluate the usefulness of having the doula present? Please use this guide to rate your experience: 1 = More harm than good 3= Neutral 5= Was a big help
Please discuss your experience with Everyday Miracles beyond working with your doula. Feel free to include your experience with classes and workshops, interactions with staff, or other services .
Name of the person completing this evaluation
Can we share your first name, comment and job title (if applicable) in our marketing materials and social media?