Birth Ways- Childbirth and Parenting Education, Classes and Referrals

Birth Ways
1600 Shattuck Ave.
Suite 122
Berkeley, CA 94709
510.869.2797

Resource Library
Located at our affiliate,
Waddle & Swaddle:
1677 Shattuck Avenue
Berkeley, CA 94709
11am - 5pm
7 days a week

Birth Professional Evaluation

Name of Practitioner:

Type of Practitioner:

PLEASE FILL OUT ALL SECTIONS OF THIS EVALUATION.

1. Please rate your experience with this Practitioner in each of the following
categories by circling your choice:

5 = Definitely 4 = Mostly 3 = Maybe 2 = Not Really 1 = NO

	5	4	3	2	1
Met your expectations
Adequately addressed all of your issues
Satisfied with the service you received
Would you recommend Practitioner to a friend
Answered questions satisfactorily
Willingness to offer personal attention
Courtesy and helpfulness

2. Please fill out this section of the evaluation as completely as possible with
details and specific examples:

What did you like the most about this practitioner?

What do you feel like this practitioner could improve?

Please share any other comments:

Clicking the submit button will automatically begin the download
of your coupon for 10% OFF at Waddle and Swaddle in Berkeley, CA.