Pregnancy Loss Support Survey
Your feedback will help us improve support services for individuals and families experiencing pregnancy loss. All responses are confidential.
Your Age
*
What is your relationship to the pregnancy loss?
*
I experienced the loss myself
Partner/spouse
Family member
Friend
Other
How long ago did the pregnancy loss occur?
*
Please Select
Within the last month
1-6 months ago
6-12 months ago
1-2 years ago
More than 2 years ago
What type of pregnancy loss did you experience?
*
Miscarriage
Stillbirth
Ectopic pregnancy
Molar pregnancy
Termination for medical reasons
Other
How would you rate the emotional support you received after your loss?
*
1
2
3
4
5
Which support resources did you access? (Select all that apply)
*
Healthcare provider (doctor, nurse, etc.)
Counseling or therapy
Support group (in-person or online)
Family and friends
Religious or spiritual support
Did not access any support
Other
Please indicate your level of agreement with the following statements:
*
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I felt supported by healthcare professionals.
1
2
3
4
5
I was given clear information about what happened.
6
7
8
9
10
I felt comfortable discussing my feelings.
11
12
13
14
15
Support resources were easy to access.
16
17
18
19
20
I would recommend support services to others.
21
22
23
24
25
What barriers, if any, did you face in accessing support? (Select all that apply)
Lack of information about available resources
Cost
Distance or transportation
Stigma or embarrassment
Lack of time
Did not feel the need for support
Other
What additional support or resources would have been helpful to you?
How likely are you to recommend our support services to others experiencing pregnancy loss?
*
Not likely at all
1
2
3
4
5
6
7
8
9
Extremely likely
10
1 is Not likely at all, 10 is Extremely likely
Is there anything else you would like to share about your experience?
Submit Survey
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