Share your experience at BREATHE Midwives

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We need to hear how the programs are working for you and what other things you would like to see. As a Register Charity, our programs are free based on donations, funding and grants. Share your experience to keep us running! This survey is voluntary and completely anonymous. We appreciate your feedback.
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Did you have access to care or resources prior to coming to BREATHE Midwives?* This field is required.
YESNO
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Did you have to pay for any of the services or resources?* This field is required.
YESNO
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How much total did you have to pay?* This field is required.
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How did you hear find out about us?* This field is required.
Please Select
Please Select
Family or Friend
Google search
Instagram
Tik Tok
Facebook
Other social media
Rexdale Community Health Centre
Other Community Health Centre
Healthcare provider
Hospital
Other
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What is your Race/Ethnicity* This field is required.
Please Select
Please Select
Black African, Black Caribbean, Black North American
East Asian
South Asian
Southeast Asian
First Nations / Indigenous / Inuit / Aboriginal / Métis
Indigenous / Aboriginal - not included elsewhere
Indian-Caribbean (e.g. Guyanaese with origins in India)
Latin American
Middle Eastern
White-European (e.g. English, Italian, Portuguese, Russian)
White-North American (e.g. Canadian, American)
Mixed ethnic census group
Other ethnic non-mixed (NMO)
Unknown
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What is your age?* This field is required.
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What city do you live in?* This field is required.This helps us know where people are coming form to use our services.
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What type of service did you access* This field is required.Please select everything that applies
Prenatal check-up
Postpartum check up
Baby check up
Feeding support
Selfcare, Nutrition and Wellness
Lending library
Care packages
Education and workshops
Home/Community visitor program
Peer Support Group
Other
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How many times have you used our services?* This field is required.
Please Select
Please Select
1 time
2 times
3 times
4 times
5 times
More than 5 times
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How do you utilize services at BREATHE Midwives?* This field is required.
Walk-in/drop in
Appointment
Registration
Virtual
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How has BREATHE Midwives help support you, a family member or friend? * This field is required.
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How has receiving care from BREATHE Midwives helped you navigate the challenges or barriers you've faced in the healthcare system?* This field is required.
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Why is receiving culturally affirming care and services important to you?* This field is required.
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Small
Ok
Ok
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What services or programs would you like to see available?* This field is required.If funding was available?
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Large
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Small
Ok
Ok
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If BREATHE Midwives was no longer available or had to cut down it's services how would this affect you or the community?* This field is required.For example if we had reduced funding due to cuts or lack of donations.
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Comments, suggestions, or feedback what is working and on how we can improve our services or programsThis year we added more days, appointment times, and have started some new programs like our mental health workshop, and care packages.
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Would you recommend BREATHE Midwives to family or friends
Yes
No
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Why would you not recommend BREATHE Midwives to your family or friend?* This field is required.
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Large
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Small
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Ok
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Are we able to use your testimony or get a letter of support if needed?* This field is required.
Yes
No
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If you would like us to contact you please share your name otherwise leave blank to be anonymously
First Name
Last Name
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if you would like us to contact you regarding your response please share your email
example@example.com
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Please verify that you are human* This field is required.
Should be Empty: