Student Midwife Feedback Survey Form
Please complete the Student Midwife Feedback Survey Form to share your structured feedback on the student midwife’s support, communication, professionalism, preparedness, and overall experience.
How would you rate the student midwife’s overall support?
*
1
2
3
4
5
How clearly did the student midwife communicate with you?
*
1
2
3
4
5
Please rate the following aspects of the student midwife’s performance.
*
Rows
Excellent
Good
Fair
Poor
Professionalism
1
2
3
4
Preparedness
5
6
7
8
Empathy
9
10
11
12
Punctuality
13
14
15
16
The student midwife demonstrated professionalism at all times.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
How prepared did you feel the student midwife was for her role?
*
Very Prepared
Prepared
Somewhat Prepared
Unprepared
Please indicate your agreement with the following statements about the student midwife.
*
Rows
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Listened attentively
17
18
19
20
21
Explained procedures clearly
22
23
24
25
26
Showed respect at all times
27
28
29
30
31
Did you feel comfortable asking the student midwife questions?
*
Yes
No
How likely are you to recommend this student midwife to others?
*
Not Likely
1
2
3
4
5
6
7
8
9
Very Likely
10
1 is Not Likely, 10 is Very Likely
What did the student midwife do particularly well?
How could the student midwife improve her practice?
Submit Feedback
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