Birth Doula Client Feedback Form

I am so grateful for the experience of working with your family. The purpose of this form is to provide a space for both positive and constructive feedback regarding my services and ability to support you as a doula. I value your voice, and it helps me to better serve families in the future. Please be as honest as possible and elaborate to your comfort level.

Name

First Name

Last Name

Did Jill meet your expectations you had when hiring a doula?

Yes

On a scale of 1 to 5, how would you rate Jill's services?

1 is the lowest, 5 is the highest

What are some of the best ways Jill supported or prepared you (think through your pregnancy, labor and birth, and the postpartum period)?

How could Jill have better supported you or prepared you (again, think through pregnancy, labor and birth, and the postpartum period)?

Would you recommend hiring Jill as a doula to your family or friends?

FYI, when you refer someone and they hire me, you get a gift card as a thank you!

Yes

Would you be willing to write a quick testimonial to be used on Jill's website (it doesn't need to include your full name)?

Thank you SO much for taking the time to fill out this form, I greatly appreciate your feedback!