Wendey
Check archives too for some discussions on patient satisfaction and surveys.
Here is one we have used in past.

TELEPHONE SURVEY

Pt's name, age, Date delivered, Vag / C-section

Breastfeeding prenatal educational background:
e.g. LLL, class,reading material, videos, other

Breastfeeding history:
1st time, 2nd time, 3rd time or more

Did you receive any breastfeeding instruction in the hospital?        Yes
              No
Comments:

How long did you plan to breastfeed your infant?
_____________________________________________
How long did you breastfeed your infant?
___________________________________________________
Why did you stop?

Did you supplement with anything (H20 / formula) while breastfeeding?
Yes               No

When was the supplementation started?

Reasons for supplementing?


Describe your breastfeeding experience using this scale:    negative
 >>>>>>>>>>>>>>>positive
1............2............3............4...........5

Would you breastfeed again?       Yes                No

Could you give us any suggestions to improve our breastfeeding program?

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA

________________________________________________________________________
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