POSTPARTUM DOULA/CHEF EXIT QUESTIONNAIRE

In an effort to continue to deepen the quality of my work and expand my offerings to further support families, I have created a brief "exit" questionnaire for the families I have supported as a postpartum doula and chef.

I truly appreciate any feedback you can offer (all fields are optional). Thank you in advance for taking the time to do this. I of course know how demanding the first year postpartum is, so there is no rush or obligation to do this! If and when you have time, I welcome your responses.

Thank you for allowing me to be a part of this joyus moment of your lives! Please stay in touch!

Name

First Name

Last Name

What did you most enjoy about my postpartum offerings?

For example: the food, our conversations, herbal tea, having in-home support, etc.

How might I improve my offerings? Was any part of the process challenging for you or lacking in some way?

I welcome constructive feedback on how I can continually refine my offerings and grow as a doula and chef!

What was your favorite dish that I prepared?

What was your least favorite dish I prepared?

Did I help you with breast/chest feeding? If so can you can you provide any feedback on the help provided?

Additional Help or Resources?

Are there any resources you feel you need that we did not discuss in-person? Do you need any support groups or other professional referrals? (Ie. ongoing lactation support, babywearing, back-to-work support, support for postpartum depression or anxiety, processing or sharing your birth story, ongoing herbal support, etc.)

Testimonial

Would you be willing to write a testimonial about my work? If so, you can write it in the box below or send it to me via email at alicia@cloveraandtimothy.com at any time! I appreciate you taking the time to do this and fully understand if it's not something you are comfortable with or have time for at present.

If you wrote a testimonial above, how would you like your name to appear?

for example/options: full name, first name with last initial, titles or profession (if you'd like to share or are in a related field) Jennifer Bridges, RN & CLC Jennifer Bridges Jennifer B.

Would you like to be added to my email list?

I send occasional emails/newsletters to announce workshops, recipes, new offerings and products. You can always unsubscribe and I take no offense if you prefer not to be included.

Yes

Email Address

Reference?

Would you be willing to be a professional reference for me in the future? If so, please know that I always check in before providing your contact info to any prospective clients. In the event it is not a good time, you will have the opportunity to let me know.

Comments & Future Offerings?

Do you have any additional notes, questions or comments? If there is something you'd like me to offer as a service or workshop in the future, please let me know!

POSTPARTUM DOULA/CHEF EXIT QUESTIONNAIRE

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