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Questionnaire template

Maternity Care Provider Evaluation

Asks people who received maternity care to evaluate access, communication, services and the quality of their care provider.

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Other · Motherhood. All Other templates

Questions in this template

First Contact and Assessment

  1. Thank you for sharing your experience of maternity care. Your answers help us see what is working well and where care should improve.

  2. When you first asked for maternity care, how long did you wait for an appointment?

    Choose one:

    • I was seen straight away
    • Within a week
    • Within a month
    • More than a month

  3. How much do you agree with each statement about your care provider?

    • My first consultation covered everything I needed.
    • My care provider paid close attention to my concerns.
    • My care provider respected my views and decisions.

    For each row: choose one:

    • Strongly disagree
    • Disagree
    • Neutral
    • Agree
    • Strongly agree

Ongoing Care

  1. How often were your check-up appointments scheduled?

    Choose one:

    • Weekly
    • Every two weeks
    • Monthly
    • Every two months
    • Other

  2. Please describe how your check-ups were scheduled.

    Condition: Shown when Other was chosen

    Open answer

  3. Which of these services were offered to you during your maternity care?

    Choose any that apply:

    • Routine ultrasound scans
    • Nutrition advice
    • One-to-one counselling
    • Antenatal classes
    • Postnatal support

  4. Anything you would like to add about these services? (optional)

    Condition: Shown when at least one service was selected

    Open answer

  5. If you received any specialist services or treatment, what were they and how was your experience?

    Open answer

Outcomes and Satisfaction

  1. How would you rate the quality of each area of your care?

    • Accurate and timely diagnosis
    • Support and respect from staff
    • Comfort and cleanliness of the facilities
    • Support and resources after the birth

    For each row: choose one:

    • Poor
    • Fair
    • Good
    • Excellent

  2. How important is each area to you?

    • Accurate and timely diagnosis
    • Support and respect from staff
    • Comfort and cleanliness of the facilities
    • Support and resources after the birth

    For each row: choose one:

    • Not important
    • Somewhat important
    • Very important
    • Essential

  3. Is there anything else you would like to tell us about your maternity care?

    Open answer