Childbirth Class Feedback Form

Thank you so much for choosing classes from Penny Simkin, Inc. We'd love your feedback about your experience.

I am the:

I am the: Pregnant Parent Partner
Who was your educator?

Who was your educator? Penny Simkin April Bolding Sharon Muza Katie Rohs & Kathy Wilson
Penny's Class Start Date

Penny's Class Start Date April 12, 2016 June 7, 2016 August 2, 2016 September 20, 2016 November 8, 2016 Other Date (please list start date) Other Date (please list start date)
April's Class Start Date

April's Class Start Date April 27, 2016 August 31, 2016 October 19, 2016 Other Date (please list start date) Other Date (please list start date)
Sharon's Class Start Date

Sharon's Class Start Date March 24, 2016 May 19, 2016 June 13, 2016 August 22, 2016 October 27, 2016 Other Date (please list start date) Other Date (please list start date)
Katie & Kathy's Class Start Date

Katie & Kathy's Class Start Date January 17, 2017 April 11, 2017 June 13, 2017 September 26, 2017
On a scale of 1 (least satisfied) to 10 (most satisfied), how satisfied were you with your childbirth instructor, and the information covered in class?
What did you enjoy most about these classes?
Do you have any suggestions for improving the course?
Instructor Feedback

Please indicate your feelings regarding the following:
	Always	Usually	Sometimes	Never
Did you feel the instructor was well informed about the material presented?	Did you feel the instructor was well informed about the material presented?Always	Did you feel the instructor was well informed about the material presented?Usually	Did you feel the instructor was well informed about the material presented?Sometimes	Did you feel the instructor was well informed about the material presented?Never
Did the instructor organize and present the material so that it was easy to follow?	Did the instructor organize and present the material so that it was easy to follow?Always	Did the instructor organize and present the material so that it was easy to follow?Usually	Did the instructor organize and present the material so that it was easy to follow?Sometimes	Did the instructor organize and present the material so that it was easy to follow?Never
Were positioning, relaxation, and comfort measures taught so that you could easily learn them?	Were positioning, relaxation, and comfort measures taught so that you could easily learn them?Always	Were positioning, relaxation, and comfort measures taught so that you could easily learn them?Usually	Were positioning, relaxation, and comfort measures taught so that you could easily learn them?Sometimes	Were positioning, relaxation, and comfort measures taught so that you could easily learn them?Never
Did you feel free to ask questions and/or contribute to the discussion?	Did you feel free to ask questions and/or contribute to the discussion?Always	Did you feel free to ask questions and/or contribute to the discussion?Usually	Did you feel free to ask questions and/or contribute to the discussion?Sometimes	Did you feel free to ask questions and/or contribute to the discussion?Never
Did you feel that your individual goals and needs were met?	Did you feel that your individual goals and needs were met?Always	Did you feel that your individual goals and needs were met?Usually	Did you feel that your individual goals and needs were met?Sometimes	Did you feel that your individual goals and needs were met?Never
Did you enjoy your classes?	Did you enjoy your classes?Always	Did you enjoy your classes?Usually	Did you enjoy your classes?Sometimes	Did you enjoy your classes?Never

Please share any comments regarding your instructor.
Who was your breastfeeding instructor?

Who was your breastfeeding instructor? Sharon Muza Dolly Smith Joy MacTavish Can't remember Other Other
Did you attend the breastfeeding class with your regular class series?

Did you attend the breastfeeding class with your regular class series? I took breastfeeding with my series. I took breastfeeding with a different series than my own.

Some families take the breastfeeding class with another series if their due date is too close to the end of class. Please indicate here if you took your class with your series, or an earlier session.
On a scale of 1 (least satisfied) to 10 (most satisfied), how satisfied were you with the information covered in the breastfeeding class?

Was your breastfeeding instructor...
Was your breastfeeding instructor...	Always	Usually	Sometimes	Never
Did you feel the instructor was well informed about the material presented?	Did you feel the instructor was well informed about the material presented?Always	Did you feel the instructor was well informed about the material presented?Usually	Did you feel the instructor was well informed about the material presented?Sometimes	Did you feel the instructor was well informed about the material presented?Never
Did the instructor organize and present the material so that it was easy to follow?	Did the instructor organize and present the material so that it was easy to follow?Always	Did the instructor organize and present the material so that it was easy to follow?Usually	Did the instructor organize and present the material so that it was easy to follow?Sometimes	Did the instructor organize and present the material so that it was easy to follow?Never
Did you feel free to ask questions and/or contribute to the discussion?	Did you feel free to ask questions and/or contribute to the discussion?Always	Did you feel free to ask questions and/or contribute to the discussion?Usually	Did you feel free to ask questions and/or contribute to the discussion?Sometimes	Did you feel free to ask questions and/or contribute to the discussion?Never
Did you feel that your individual goals and needs were met?	Did you feel that your individual goals and needs were met?Always	Did you feel that your individual goals and needs were met?Usually	Did you feel that your individual goals and needs were met?Sometimes	Did you feel that your individual goals and needs were met?Never

Please share any comments regarding your breastfeeding instructor.
Class Format and Topics

Please share your feedback about teaching methods and materials used in your class.

I would prefer:
I would prefer:	More	About the same	Less
Lecture/Group Discussion	Lecture/Group DiscussionMore	Lecture/Group DiscussionAbout the same	Lecture/Group DiscussionLess
Slides	SlidesMore	SlidesAbout the same	SlidesLess
Comfort Measures Practice	Comfort Measures PracticeMore	Comfort Measures PracticeAbout the same	Comfort Measures PracticeLess
Interactive activities	Interactive activitiesMore	Interactive activitiesAbout the same	Interactive activitiesLess
Small/large group activities	Small/large group activitiesMore	Small/large group activitiesAbout the same	Small/large group activitiesLess
Videos	VideosMore	VideosAbout the same	VideosLess

I would prefer:
I would prefer:	More	About the same	Less
Lecture	LectureMore	LectureAbout the same	LectureLess
Group Discussion	Group DiscussionMore	Group DiscussionAbout the same	Group DiscussionLess
Slides	SlidesMore	SlidesAbout the same	SlidesLess
Comfort Measures Practice	Comfort Measures PracticeMore	Comfort Measures PracticeAbout the same	Comfort Measures PracticeLess
Interactive activities	Interactive activitiesMore	Interactive activitiesAbout the same	Interactive activitiesLess
Videos	VideosMore	VideosAbout the same	VideosLess

Are there any subjects to which you wish more time had been devoted?
What information covered in class will be most applicable to your birth experience?
Class Logistics

Please provide feedback about the registration process, handouts, and classroom space.
I would prefer (check all that apply)

I would prefer (check all that apply) Earlier class start/end time Later class start/end time Fewer people in the class More people in the class
On a scale of 1 (least satisfied) to 10 (most satisfied), how satisfied were you with the registration process?
On a scale of 1 (least useful) to 10 (most useful) how useful were the class handouts?
Comments about class logistics (including registration, handouts, classroom space, start/end time, class size).
On a scale of 1 (least likely) to 10 (most likely), how likely would you be to recommend these classes to a friend?
Do you have any concerns about your class that you would like to discuss?

Do you have any concerns about your class that you would like to discuss? Yes No
May we use some of your comments for class descriptions and/or marketing purposes?

May we use some of your comments for class descriptions and/or marketing purposes? Yes! (OK to share my first name too!) Yes! (Please use only my initials.) No, I prefer not.
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Contact Information

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Childbirth Class Feedback Form

Childbirth Class Feedback Form

Instructor Feedback

Class Format and Topics

Class Logistics

Contact Information