Care Package Feedback Form - Missing Pieces Support Group

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Care Package Feedback

We know receiving a care package means you’ve walked through something incredibly difficult. Your voice is important to us, but only if and when you’re ready. Whether you received your care package recently or many months ago, we’re grateful you’re here.

This short survey takes about 2-5 minutes and helps us gather insight for improving our support, strengthening our ability to secure grant funding, and reach more families.

Everything you share will remain completely confidential and unidentifiable, unless you tell us otherwise. Your privacy and trust are deeply respected.

We collect your email, first, and last name only to help us manage duplicate responses in our system.

Name

First

Last

Phone

Optional if you'd like to receive future follow-ups through text

Zip Code

We ask for your zip code to better understand the geographic reach of our services. This information is used internally only.

Your Experience with the Care Package

We’re so glad you received a care package from Missing Pieces Support Group. This survey helps us improve our support and reach more families. Thank you for being here.

When did you receive your care package?

If you don't remember the exact date, please estimate

us of Race/Ethnicity

Please indicate how much you agree with the following statements about your experience with your care package.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
When I received my care package, I felt supported.	Strongly DisagreeWhen I received my care package, I felt supported. Strongly Disagree	DisagreeWhen I received my care package, I felt supported. Disagree	NeutralWhen I received my care package, I felt supported. Neutral	AgreeWhen I received my care package, I felt supported. Agree	Strongly AgreeWhen I received my care package, I felt supported. Strongly Agree
Receiving the care package helped my loss feel seen, recognized, or validated.	Strongly DisagreeReceiving the care package helped my loss feel seen, recognized, or validated. Strongly Disagree	DisagreeReceiving the care package helped my loss feel seen, recognized, or validated. Disagree	NeutralReceiving the care package helped my loss feel seen, recognized, or validated. Neutral	AgreeReceiving the care package helped my loss feel seen, recognized, or validated. Agree	Strongly AgreeReceiving the care package helped my loss feel seen, recognized, or validated. Strongly Agree
The care package had a positive impact on my emotional wellbeing.	Strongly DisagreeThe care package had a positive impact on my emotional wellbeing. Strongly Disagree	DisagreeThe care package had a positive impact on my emotional wellbeing. Disagree	NeutralThe care package had a positive impact on my emotional wellbeing. Neutral	AgreeThe care package had a positive impact on my emotional wellbeing. Agree	Strongly AgreeThe care package had a positive impact on my emotional wellbeing. Strongly Agree
The care package gave me ideas for small acts of self-care.	Strongly DisagreeThe care package gave me ideas for small acts of self-care. Strongly Disagree	DisagreeThe care package gave me ideas for small acts of self-care. Disagree	NeutralThe care package gave me ideas for small acts of self-care. Neutral	AgreeThe care package gave me ideas for small acts of self-care. Agree	Strongly AgreeThe care package gave me ideas for small acts of self-care. Strongly Agree
The care package helped me feel more connected to support or community.	Strongly DisagreeThe care package helped me feel more connected to support or community. Strongly Disagree	DisagreeThe care package helped me feel more connected to support or community. Disagree	NeutralThe care package helped me feel more connected to support or community. Neutral	AgreeThe care package helped me feel more connected to support or community. Agree	Strongly AgreeThe care package helped me feel more connected to support or community. Strongly Agree
The care package increased my awareness of support options available to me.	Strongly DisagreeThe care package increased my awareness of support options available to me. Strongly Disagree	DisagreeThe care package increased my awareness of support options available to me. Disagree	NeutralThe care package increased my awareness of support options available to me. Neutral	AgreeThe care package increased my awareness of support options available to me. Agree	Strongly AgreeThe care package increased my awareness of support options available to me. Strongly Agree
I have shared items or resources from the care package with a partner, family member, or loved one.	Strongly DisagreeI have shared items or resources from the care package with a partner, family member, or loved one. Strongly Disagree	DisagreeI have shared items or resources from the care package with a partner, family member, or loved one. Disagree	NeutralI have shared items or resources from the care package with a partner, family member, or loved one. Neutral	AgreeI have shared items or resources from the care package with a partner, family member, or loved one. Agree	Strongly AgreeI have shared items or resources from the care package with a partner, family member, or loved one. Strongly Agree
The care package continues to bring me comfort or benefit today.	Strongly DisagreeThe care package continues to bring me comfort or benefit today. Strongly Disagree	DisagreeThe care package continues to bring me comfort or benefit today. Disagree	NeutralThe care package continues to bring me comfort or benefit today. Neutral	AgreeThe care package continues to bring me comfort or benefit today. Agree	Strongly AgreeThe care package continues to bring me comfort or benefit today. Strongly Agree
I would recommend these care packages to someone else experiencing a pregnancy loss.	Strongly DisagreeI would recommend these care packages to someone else experiencing a pregnancy loss. Strongly Disagree	DisagreeI would recommend these care packages to someone else experiencing a pregnancy loss. Disagree	NeutralI would recommend these care packages to someone else experiencing a pregnancy loss. Neutral	AgreeI would recommend these care packages to someone else experiencing a pregnancy loss. Agree	Strongly AgreeI would recommend these care packages to someone else experiencing a pregnancy loss. Strongly Agree