Evaluation of Doula Care

Doula's Name:
I am a Mother Father Partner Other Relative Other
This is my # child. Baby's birth date
My doula provided



Please rate your doula
On Scale of 1 to 7, where: 1 = Terrible 3 = So-so 5 = Good 7 = Excellent
Was engaging and approachable 1 2 3 4 5 6 7
Gave clear answers and explanations 1 2 3 4 5 6 7
Inspired self-confidence 1 2 3 4 5 6 7
Was accessible and helpful during our labour 1 2 3 4 5 6 7
Interacted with our healthcare team in a professional and helpful manner 1 2 3 4 5 6 7
Was accessible and helpful immediately after the baby was born and in the weeks following 1 2 3 4 5 6 7

What I liked and/or valued most about my doula care and why:

What I had the most trouble relating to was:

How doula care influenced my spouse's/partner's attitude or experience towards labour, birth, and parenting:

How doula care influenced our relationship:

One thing my doula could have done better, or more or less of, that would have enhanced my experience or my feeling of being prepared is:

Anything else I want to share about my doula and/or my birthing process:
I wish to remain anonymous
You may use my name and comments publicly

Name: Email:
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