Quality of Care Evaluation Form
Please take some time to provide us with your evaluation of the midwifery care that you received during your recent pregnancy, birth and postpartum periods. You do not need to identify yourself unless you would prefer to do so. Your comments will be reviewed by the midwifery practice and can help us to improve the quality of care we provide to clients.
  • Excellent Good Fair Poor
    Number of prenatal visits
    Length of prenatal visits
    Scheduling of prenatal visits
    Usefulness of information provided for making decisions
    How easy it was to reach my midwives
    My confidence in the midwives skills & abilities
    How comfortable I felt asking questions
  • Excellent Good Fair Poor
    How easy it was to reach my midwives during labour
    My confidence in the midwives skills and abilities
    Usefulness of information provided to me for making decisions
  • Excellent Good Fair Poor
    Number of postpartum visits
    Length of postpartum visits
    Scheduling of Postpartum visits
    How easy it was to reach my midwives
    Usefulness of information about caring for myself
    Usefulness of information about caring for my baby
    My comfort calling my midwives with questions or problems
    My confidence in the midwives skills and abilities
  • Yes No
    Did you know which midwife or midwives were primarily responsible for your care?
    Were there adequate opportunities for you to meet the midwives involved in your care?
    Did you understand how to reach a midwife 24 hours a day?
  • Yes No
    In general, were your choices and decisions respected by your midwives?
    Did you receive enough information to make informed decisions about your care?
    Were you given enough information to decide where to have your baby's birth?
  • Yes No N/A
    Did you understand the reasons why a doctor might become involved in your care?
    Did you midwife need to consult during your care?
    If so, did you understand why and what would happen?
    Was your care transferred to a doctor?
    If so, did you understand why and what would happen?
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