Doula Evaluation Form

Your Name*
First Last
Email*
Baby's Name*
First Last
Baby's Birthday*
MM slash DD slash YYYY
Doula's Name*
First Last
Please rate your doula's services below. If an item doesn't apply to you, please leave it blank.
Mothercare/Emotional Support
Not at all useful Somewhat useful Useful Very useful Exceptionally useful
Newborn Care/Guidance
Not at all useful Somewhat useful Useful Very useful Exceptionally useful
Breastfeeding Assistance
Not at all useful Somewhat useful Useful Very useful Exceptionally useful
Household Help
Not at all useful Somewhat useful Useful Very useful Exceptionally useful
Family & Sibling Support
Not at all useful Somewhat useful Useful Very useful Exceptionally useful
Was your doula understanding and comfortable to be around?*
Not at all Somewhat Yes Very much Exceptional
Was she sensitive and respective to all family members?*
Not at all Somewhat Yes Very much Exceptional
Was she knowledgeable about postpartum care?*
Not at all Somewhat Yes Very much Exceptional
Is there anything you would change about your doula?*
- Yes
- No
Please explain to better help us understand.
Were there any areas in which you wish she had more knowledge?*
- Yes
- No
Please explain to better help us understand.
May we use your name when contacting your physician about our service?*
- Yes
- No
Additional Comments
Name
This field is for validation purposes and should be left unchanged.

(412) 779-5976

Connect With Us!

Register Now

It’s easy to register now for Pittsburgh Doula Network service. Just fill out our online form and complete payment via Paypal. We will get in touch soon to confirm and schedule an acquaintance visit.

LABOR & BIRTH DOULAS

The Pittsburgh Doula Network specializes in postpartum doulas. If you're looking for a labor and birth doula, please visit our sister group Birth Doulas of Pittsburgh.

IMPORTANT NOTE

Doulas provide non-medical care. Please consult your health care provider for medical advice.

Perinatal Loss

Pregnancy loss is unexpected and usually sudden. Please take a moment to read our page on perinatal loss so that you can learn more about prevention, and where to turn if you find yourself experiencing miscarriage, stillbirth or your baby has been given a life-limiting diagnosis.

Get in touch!

Pittsburgh Doula Network
(412) 779-5976
[email protected]

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Postpartum Depression
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Please rate your doula's services below. If an item doesn't apply to you, please leave it blank.

LABOR & BIRTH DOULAS

IMPORTANT NOTE

Perinatal Loss

Get in touch!