Prenatal Supplement Uptake Survey Form

Prenatal Supplement Uptake Survey Form
Please complete this brief survey about your experiences and opinions on prenatal supplement use. Your responses are anonymous.
Which of the following best describes your current status?
How often do you currently take prenatal supplements?
Which types of prenatal supplements do you currently use? (Select all that apply)
Other
How important do you believe taking prenatal supplements is during pregnancy?
What are your main reasons for taking prenatal supplements? (Select all that apply)
Other
What barriers, if any, make it difficult for you to take prenatal supplements as recommended? (Select all that apply)
Other
How did you first learn about prenatal supplements?
Other

Please indicate your level of agreement with the following statements about prenatal supplements.

Rows	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Prenatal supplements are necessary for a healthy pregnancy.
I feel confident choosing the right supplements.
I receive enough information about prenatal supplements.
I trust the quality of available prenatal supplements.

What is your age group?
If you have any additional comments about prenatal supplement use, please share them below.
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