Evaluation Evaluation Your opinion about our organization in general and especially the maternity period is very important to us. Therefor we would like to ask you to fill out this evaluation form. This way we can monitor the quality of our organization and improve where necessary Evaluation maternity period Name Client number: Address: Zip Code and City: Postnatal period from: till: Name kraamverzongende: Total hours of maternity care: How did you become familiar with the maternity care organization? midwifeGeneral practitionerwebsiteother viz: Please indicate on a scale of 1 to 5 what is your opinion about: 0 = does not apply 1= strong need for improvement 2= need for improvement 3= sufficiently 4= good 5= excellent Organization in general Our website:012345 The information brochure:012345 The interview during pregnancy:012345 The degree of information about the activities of the kraamverzorgende:012345 Our organization’s overall communications:012345 Your treatment by our office services:012345 Organization in general:012345 Would you recommend our organization to others?YesNo Do you have any further comments? Kraamverzorgenden Assistance during home birth:012345 Check-ups and your own care:012345 Check-ups and care for the baby:012345 Providing information and guiding regarding breastfeeding:012345 Providing information and guidance regarding formula feeding:012345 Advice about your own nutrition:012345 Domestic chores performed by the kraamverzorgende:012345 The handling of the maternity nurse with other family members and visitors:012345 Consideration of your needs:012345 Controles en verzorging van uw baby:012345 Making clear agreements between you and the kraamverzorgende:012345 The flexible adjustment of the kraamverzorgende:012345 Clear/the same work by several kraamverzorgende:012345 Use of Growth Guide by the kraamverzorgende:012345 The maternity period overall:012345 Enlisted the help of a lactation consultant?YesNo If yes, is this lactation consultant provided by the organization? YesNodna Attended breastfeeding information course from organization/hospital/otherYesNo If yes, did you find this course useful?YesNodna Do you have any further comments about the maternity care period?
