Discovery Questionnaire
Contact Information
Name
*
First Name
Last Name
Title
*
Department
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Company Information
Company Name
*
Company Size
1-10
11-50
51-200
201-500
501-1000
1000-5000
5000+
Industry
Company Workplace Culture
1) On average, how many employees are out on maternity leave monthly?
1-5
5-10
10-15
15-20
20+
Other
2) What is the female to male ratio within the company?
3) What are the top 3 parental or maternity leave benefits the company currently offers?
4) Will staff continue to work remotely post COVID-19?
Yes
No
5) What virtual support services do you currently have in place for parents?
Please verify that you are human
*
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