Tell Us About Your ExperienceFeedback is important to us, we would love to hear about your experience with your Birth in Color Doula. You can use this form to share about your experience with any Birth in Color location in Virginia. Thank you for your feedback! Leave a Review Client Experience Survey Name * First Name Last Name Email * Birth in Color Location * Richmond Hampton Roads Lynchburg South West VA Roanoke Northern Neck Date you gave birth * MM DD YYYY Doula Name * First and last name of your doula Location of Birth * Name of the hospital, birth center, or home birth I would rate my experience with my doula as ... * Excellent Good Fair Poor Please share why you selected the experience rating above. * Explain why you chose excellent/good/fair/poor to describe your experience with your doula. Choose the response that is most accurate for you. * I would recommend my doula to a friend: Strongly Disagree Disagree Neutral Agree Strongly Agree I would request my doula again if I have another pregnancy: Strongly Disagree Disagree Neutral Agree Strongly Agree I would recommend Birth in Color to a friend: Strongly Disagree Disagree Neutral Agree Strongly Agree I would apply for doula care WITH A DIFFERENT Birth in Color Doula if I have another pregnancy: Strongly Disagree Disagree Neutral Agree Strongly Agree Do you have any other feedback about your doula? Please share below; if you do not have feedback for this field, you may skip this question. Do you have any feedback about your care provider that you would like us to know about? (NOT your doula) Did you have a great experience with your OB, Midwife, Nurses, etc.? Did you have any negative experiences with your OB, Midwife, Nurses, etc.? Do you have any other feedback for Birth in Color RVA? Please share below; if you do not have feedback for this field, you may skip this question. I give Birth in Color RVA permission to share my review on the Birth in Color Website or Social Media * No, please keep my review for internal use only. Yes, but please keep my name anonymous. Yes, Birth in Color RVA can share my name with my review. Thank you for sharing your feedback. Your experience is important to us and we are glad to have served you during your pregnancy. We believe in growth and professional development. Your review may be shared with your Doula to help them continue to serve their clients to the best of their ability.
