|
Congratulations and thank you for inquiring about our New Mom Checklist and Resource Magnet. We hope that you find these useful as you prepare for your new addition and then again once you bring home your baby.
We ask that you take a few moments to answer the questions below and register for our drawing. You can win fabulous prizes such as a sleep sack, cooler bag, diapers, photography gift certificate, Target gift card, baby massage gift certificate and more. The drawing will take place on December 15, 2011. Winners will be contacted and posted on our website later that week.
|
|
| Have you Received your New Mom Checklist Packet? | | yes no If NO click here |
|
| Where did you receive your New Mom Checklist packet? | | |
|
| What is your baby's due date? ( month/date/year) | | |
|
If you have not yet given birth to your baby, go directly to Question #3If you have already given birth to your baby and brought him/her home, then start with Question #1
|
|
| 1. Were any of the items on the New Mom's Checklist helpful to you? |
| Apply for Birth Certificate & Social Security Card? | | yes no |
|
| Add newborn to Medical Insurance policy. | | yes no |
|
| Get Instructions for "safe sleep for your baby". | | yes no |
|
| Schedule a two-week baby check-up with your pediatrician. | | yes no |
|
| Schedule CPR training with the Red Cross. | | yes no |
|
| Schedule a car seat safety check. | | yes no |
|
| Are there any other items you would recommend for this checklist? | | |
|
| 2. Did you utilize any of the resources on the Resource Magnet? |
|
| Help with breast feeding | | yes no |
|
| Help with food assistance | | yes no |
|
| Help with post-partum depression | | yes no |
|
| Child development information/milestones | | yes no |
|
| Childcare referrals and information | | yes no |
|
| Help if your baby won't stop crying | | yes no |
|
| If you would like a FREE home nurse visit | | yes no |
|
| Help with diapers and/or baby clothes | | yes no |
|
| Great Start Livingston | | yes no |
|
| All other resources | | yes no |
|
| Are there any other resources you would recommend to moms? | | |
| |
|
| 3. Thank you for taking the time to fill out this survey and ultimately help new moms in Livingston County. By supplying the information below, you will automatically be entered into our drawing that will take place on December 15, 2011. For those who have not yet had their babies, we may be contacting you via email to complete the survey after you give birth.
|
|
| Name | | |
|
| Email Address | | |
|
| Phone Number | | |
|
| | | |
| Confidentiality: Your e-mail address will not be traded or sold and is for the sole use of Great Start Livingston.
|
