d) Survey Example

There are many ways that you could use a survey. Think about what information you would need to assess. Below is just an example survey form…do not complete this form.

Survey about Doula Services

First Name and Last Name *

Email Address *

Phone Number

Do you know what a doula is?

Yes

No

What would you need from a doula?

help during birth

education about birth

attend doctor appointments with me

help with my birth plan

help the first few weeks with new baby

breastfeeding assistance

light housekeeping

Other

If you selected other, then tell us what else you would need...

What would you pay for a doula?

Which business name do you like?

Mommy Love and Support

Empowered Birth Support

Doula Connection Service

Next Talk to Customers

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