Name
First Name
Last Name
Email
How would you rate your overall experience at Birth Acadiana Chiropractic?
1 (Poor)
2
3
4
5 (excellent)
What brought you to Birth Acadiana Chiropractic?
How did your birth experience go?
Vaginal Birth with no interventions
Vaginal Birth with minimal interventions
Vaginal birth with interventions (ex. epidural, forceps, induction, etc.)
Planned C-Section
Emergency C-Section
Check off who was part of your birth team & birth prep.
What # baby was this for you?
1st
2nd
3rd
4th
5th
6th
7th
8th
Did you feel prepared for your birth experience?
Yes, I felt very prepared
Somewhat, I wish I had more information or resources.
No, I felt unprepared
If you answered 'somewhat' or 'no' for the previous question please explain why.
What is something you wish you would have known now that you are postpartum?
What was the biggest benefit from working with Dr. Alayna Clark
Did you feel heard, supported, and cared for during your visits?
Yes, absolutely
Somewhat
Not really
If you answered 'somewhat' or 'not really' for the previous question please share feedback.
What changes or improvements have you noticed in your body, pregnancy, and/or baby after receiving care?
Is there anything you wish we had done differently or better?
Would you recommend Birth Acadiana Chiropractic to other moms? Why or why not?
Which of these additional services or resources would interest you?
check all that apply
What other resources would you like to see that we may not have listed.
