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Simply Birthed
Please take a few moments to tell us more about you and your preferences
10
Questions
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1
Are you currently pregnant?
Yes, first trimester
Yes, second trimester
Yes, third trimester
No, trying to conceive
No, just gave birth (child 0-6 months)
No, child is 7 months to 1 year
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2
Is this your first pregnancy?
Yes
No
Prefer not to answer
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3
Were you satisfied with your previous birthing experience?
Yes
No
This is my first pregnancy
Prefer not to answer
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4
What is your age?
Under 18
18-24
25-29
30-34
35-40
41 or older
Prefer Not to Answer
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5
Are you happy with the care from your current provider?
OB/GYN or Midwife
Yes
No
I have not yet established care with a provider
Prefer not to answer
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6
Would you be interested in having 24/7 communication with a doula or nurse?
Yes
No
Yes, please tell me more
What is a doula?
Unsure
Other
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7
Do you plan to have an unmedicated birth?
Yes
No
Unsure
What is an unmedicated birth?
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8
Do you plan to have a doula present at your birth?
Yes
No
Unsure
What is a doula?
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9
Would you be interested in downloading an app that is tailored to fit your unique pregnancy experience and connects you with your own personal support team?
Yes
No
Yes, tell me more
Unsure
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10
Please share your email address to be entered to win a FREE gift.
optional
example@example.com
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