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Age:
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Zip
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1. Where are you currently going for care?
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Nurse Midwife
Family Dr.
OB/Gyn Dr.
Nurse Practitioner
Physicians's Assistant
Lay Midwife
Internal Medicine Dr.
Maternal Health Clinic
Family Planning Clinic
Other
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If Other:
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2. How did you select your health care provider?
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Location
Speciality of provider (ie. midwife, OB/Gyn
Reputation (word of mouth, recommendation)
Friend/Relative
Other
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If Other:
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3. Have you sought out an alternative/complementary health provider (ie. chiropractor, homeopath, herbalist, massage therapist) in the past 3 years?
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Specify type consulted and why?
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4. Would you consider seeing a nurse-midwife who has hospital privileges and works with a collaborating physician for maternity or gynecologic care?
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5. If you are (were) pregnant or planning a pregnancy, would you consider using an OUT OF HOSPITAL BIRTH CENTER for your prenatal &/or birthing care?
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If yes, how far would you drive to seek this kind of care?
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If no, what is the main reason you would not consider this choice?
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6. List 3-5 services related to prenatal, birth and postpartum care which, if available in one place, would attract you to drive up to 50 miles to seek care at that facility.
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7. Below is a list of supplemental services that are sometimes associated with women's healthcare. Please check all services you personally would consider using:
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Nurse Midwife
Family Medicine Dr
OB/Gyn Dr
Nurse Practitioner
Physician's Assistant
Osteopathic Care
High Risk OB Care/Perinatologist
Genetic Counseling
Out of Hospital Birthcenter
Homebirth
Doula Program
Water Massage (Watsu)
Water Therapy
Massage Therapy
Yoga
Nutrition Counseling
Prenatal Yoga
Library or References Services
Prenatal Exercise Program
Childbirth Education (nonspecific)
Centering Prenatal Care (Group Ed visits)
Bradley Childbirth classes
Postpartum Support Groups
HypnoBirthing
Parenting Classes
Lamaze Childbirth Classes
Sibling Classes
Lactation Support/Breastfeeding classes
Infant Massage Classes
Perimenopause/Menopause Herbal or Natural Medicines
Chiropractic Care
Colposcopy
Acupuncture
Tobacco, Alcohol & Drug Cessation Program
Medical Hypnosis
Energy Work (ie. Reiki, etc)
Acupressure Massages
Tai Chi
Life Style Changes Program
Creative Memories, ie. Belly Casting, Creative Photography
Counseling services (ie., depression,relationshipissues, etc); individual or group
Level 4 Ultrasound
Infertility Services
Adoption Services
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Comments
Thank You For Taking our Survey! |
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