Loss Support Feedback

Our loss support programs are offered free of charge, thanks to the generous funding we receive through grants and donations. Your feedback helps us continue offering these services while improving them to better support you and others in the future.

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

This information is confidential.

Zip code

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

What was the format of the support session you attended?

In-person
Virtual
Phone call

What is the date of the session you last attended?

If you don’t remember the exact date, please estimate.

Your Experience with the Loss Support Session

Your voice matters to us. Please share your honest feedback. It helps us understand what’s working, what could be improved, and how we can better support you and others on this healing journey.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
The meeting(s) helped me feel more prepared to get through the holidays	Strongly DisagreeThe meeting(s) helped me feel more prepared to get through the holidays Strongly Disagree	DisagreeThe meeting(s) helped me feel more prepared to get through the holidays Disagree	NeutralThe meeting(s) helped me feel more prepared to get through the holidays Neutral	AgreeThe meeting(s) helped me feel more prepared to get through the holidays Agree	Strongly AgreeThe meeting(s) helped me feel more prepared to get through the holidays Strongly Agree

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

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Overall, I was satisfied with the session.	Strongly DisagreeOverall, I was satisfied with the session. Strongly Disagree	DisagreeOverall, I was satisfied with the session. Disagree	NeutralOverall, I was satisfied with the session. Neutral	AgreeOverall, I was satisfied with the session. Agree	Strongly AgreeOverall, I was satisfied with the session. Strongly Agree
I felt comfortable sharing my experiences and emotions.	Strongly DisagreeI felt comfortable sharing my experiences and emotions. Strongly Disagree	DisagreeI felt comfortable sharing my experiences and emotions. Disagree	NeutralI felt comfortable sharing my experiences and emotions. Neutral	AgreeI felt comfortable sharing my experiences and emotions. Agree	Strongly AgreeI felt comfortable sharing my experiences and emotions. Strongly Agree
The facilitator created a safe and supportive space for sharing.	Strongly DisagreeThe facilitator created a safe and supportive space for sharing. Strongly Disagree	DisagreeThe facilitator created a safe and supportive space for sharing. Disagree	NeutralThe facilitator created a safe and supportive space for sharing. Neutral	AgreeThe facilitator created a safe and supportive space for sharing. Agree	Strongly AgreeThe facilitator created a safe and supportive space for sharing. Strongly Agree
The topics covered in the session were relevant and helpful to my needs.	Strongly DisagreeThe topics covered in the session were relevant and helpful to my needs. Strongly Disagree	DisagreeThe topics covered in the session were relevant and helpful to my needs. Disagree	NeutralThe topics covered in the session were relevant and helpful to my needs. Neutral	AgreeThe topics covered in the session were relevant and helpful to my needs. Agree	Strongly AgreeThe topics covered in the session were relevant and helpful to my needs. Strongly Agree
The session schedule and format supported my healing process.	Strongly DisagreeThe session schedule and format supported my healing process. Strongly Disagree	DisagreeThe session schedule and format supported my healing process. Disagree	NeutralThe session schedule and format supported my healing process. Neutral	AgreeThe session schedule and format supported my healing process. Agree	Strongly AgreeThe session schedule and format supported my healing process. Strongly Agree
The resources/handouts provided were helpful and informative.	Strongly DisagreeThe resources/handouts provided were helpful and informative. Strongly Disagree	DisagreeThe resources/handouts provided were helpful and informative. Disagree	NeutralThe resources/handouts provided were helpful and informative. Neutral	AgreeThe resources/handouts provided were helpful and informative. Agree	Strongly AgreeThe resources/handouts provided were helpful and informative. Strongly Agree
Participating in the session had a positive impact on my mental wellbeing.	Strongly DisagreeParticipating in the session had a positive impact on my mental wellbeing. Strongly Disagree	DisagreeParticipating in the session had a positive impact on my mental wellbeing. Disagree	NeutralParticipating in the session had a positive impact on my mental wellbeing. Neutral	AgreeParticipating in the session had a positive impact on my mental wellbeing. Agree	Strongly AgreeParticipating in the session had a positive impact on my mental wellbeing. Strongly Agree
I would recommend this loss support to others.	Strongly DisagreeI would recommend this loss support to others. Strongly Disagree	DisagreeI would recommend this loss support to others. Disagree	NeutralI would recommend this loss support to others. Neutral	AgreeI would recommend this loss support to others. Agree	Strongly AgreeI would recommend this loss support to others. Strongly Agree

covered? your you

Help Us Grow & Improve

These next questions help us gather further insight for improving our support, strengthening our ability to secure grant funding, and reaching more families. Answer only what you’re comfortable with.

What part(s) of the session(s) felt the most valuable or meaningful to you?

What other types of support groups, workshops, or topics would you find helpful in the future?

Examples: Spanish-speaking groups, infertility and loss, partner-focused sessions, etc.

What specific changes or improvements would you suggest for future sessions?

Do you have any feedback about the facilitator who led your session?

What did you find most helpful about the facilitator? Is there anything the facilitator could do differently to better support you?

Any additional comments regarding the sessions?

Are you willing to share your story/experience as a testimonial?

Yes
No thank you

Would you be comfortable with us using any of your responses (such as quotes or reflections) to help others understand the impact of our loss support sessions?

Yes, you may share my words and use my first name
Yes, you may share my words, but please keep them completely anonymous
I do not want my responses to be used or quoted in any way

Please choose the option that feels right for you

Help Us Extend Our Support to Others

These questions help us better understand who we’re reaching and supports our grant applications, so we can continue improving access to care and support for everyone in our community.

Answer only what you’re comfortable with.

Date of Birth

Gender

Female
Male
Prefer not to say
Other

We know gender identity is diverse and these labels may not reflect everyone’s experience. Our database currently only supports the options below, though we recognize they are not fully inclusive.

Race/Ethnicity

Our programs are free thanks to grant funding from foundations that require us to share demographic information. By answering, you help us show the reach and impact of MPSG, which makes it possible to continue offering support at no cost. We’re grateful for your help.

Communities, Identities, Experiences

To help us better understand who we’re reaching, feel free to share any other communities or experiences you identify with that are meaningful to you (e.g., cultural background, LGBTQ+, faith, veteran, health conditions, etc.)

What is your connection to pregnancy loss?

Personally experienced pregnancy loss
Partner has experienced pregnancy loss
Close friend or family member has experienced pregnancy loss
No experience with pregnancy loss, but support the cause
Prefer not to say

(Select the option that best applies to you)