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Bereavement Care Survey
Did you receive a Rachel's Gift Keepsake Box? We'd like to hear from you! Your valuable input will help us improve our services to other moms and families enduring pregnancy and infant loss.
Select the hospital where you received your keepsake box.
1. Is there a particular decision you had to make while in the hospital that you wish you could have received more guidance and information on?
If yes, please explain:
2. Do you feel you were given every opportunity to spend time with your baby while in the hospital?
If no, please share why not: (optional)
3. Is there anything you wish you had done differently or made a different decision about?
If yes, please explain:
4. What was the most difficult decision you had to make while you were in the hospial?
5. Do you feel you were provided with enough options regarding end of life planning for your baby?
If no, comment here: (optional)
6. Do you feel you were treated with compassion and empathy by hospital staff?
If no, why not? (optional)
7. Do you feel you were treated with compassion and empathy by your doctor or midwife?
If no, why not? (optional)
Doctor's Name/OB Office
8. If there is a special person you would like to recognize who provided you with excellent support while in the hospital, please provide that staff member's name:
If you wish to remain anonymous, your survey is complete. If you don't mind sharing your name and email in case we have follow up questions to help us improve services or to address issues at a facility, please enter your contact information below. If we contact a hospital about an issue we will never disclose where the information came from unless you give express written consent for us to do so.
Submit
Thanks for sharing your experience with us.
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