Antenatal Consultation Questionnaire
The following questionnaire is designed to gain a greater understanding of the service provided by Antenatal Consultants and the impact on parents of preterm infants.
Please download the following questionnaire 'Antenatal Consultation - questionnaire' here (at the bottom of the page). Once complete please save it and email it back to
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The follow questionnaire is not a functional online questionnaire and only serves as an example of the downloadable questionnaire (available at the bottom of the page- here )
Carer Details
Hospital - Enter Hospitial Here
Country - Enter County Here
Consultation provided by
Neonatologist
Neonatal fellow
Neonatal nurse practitioner
Pediatrician
Other _________________
Length of consultation
The Neonatal Specialist:
- 1.Gave me information about medical problems that my baby might have
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 2.Gave me information about treatments my baby might need
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 3.Gave me information about the chances of survival for my baby
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 4.Gave me information about the risk of mental or physical disability for my baby
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 5.Gave me information about breastfeeding my premature baby
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 6.Explained the difference between level II and level III care
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 7.Gave me information about how long my baby could be in hospital
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 8.Gave me information about when we could visit my baby in the neonatal intensive care unit
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 9.Gave me information about who could visit my baby in the neonatal intensive care unit
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 10.Gave me a chance to ask questions
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 11.Answered my questions in words that were easy to understand
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 12.Asked if I understood the information discussed
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 13.Took time to explain information that I did not understand
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 14.Asked if I had questions about information that had not been discussed
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 15.Gave me a chance to talk about my pregnancy
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 16.Gave me a chance to talk about how I was feeling
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 17.Gave me a chance to talk about what I was worried about
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 18.Gave me a chance to talk about my knowledge of premature babies
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 19.Gave me a chance to talk about my baby
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 20.Explained his/her role in the care of my baby
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 21.Explained that the neonatal intensive care unit team would begin care in the delivery room
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 22.Told me that my baby would be admitted to the neonatal intensive care unit
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 23.Explained that the neonatal intensive care unit team would be available at all times for attendance at the delivery
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 24.Explained that I was not responsible for my premature labour
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 25.Made it easy for me to talk about what I was worried about
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 26.Told me another meeting could be arranged for further questions
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 27.Offered me a tour of the neonatal intensive care unit to help me understand my baby’s care
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
- 28.I found it easy to talk to the neonatal specialist
Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
Additional Questions
- 29.Is there any other information you felt you should have received but didn’t?
- 30.What could have been done to improve your overall satisfaction with the consultation?
End Questionnaire.
Please download the following questionnaire 'Antenatal Consultation - questionnaire' here (at the bottom of the page). Once complete please save it and email it back to
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
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