NAPS Doulas Evaluation/Evaluación

Thank you for taking the time to complete this evaluation. Please mail this form to NAPS Doulas or return directly to your doula. This form will be used for your doula’s certification/re-certification or to assist the doula with continued learning. You may be contacted by a NAPS Doulas representative to confirm the details of this form. If you have questions, please feel free to contact NAPS Doulas at (206) 956-1955 or info@napsdoulas.com

Gracias por tomarse el tiempo para completar esta evaluación. Este formulario se utilizará para la certificación / recertificación de su doula o para ayudar a la doula con el aprendizaje continuo. Es posible que un representante de nuestra organización NAPS se comunique con usted para confirmar los detalles de este formulario.
Esta forma está disponible en línea en www.napsdoulas.com/parent-evaluations
Si tiene preguntas, no dude en comunicarse con NAPS Doulas al (206) 956-1955 o info@napsdoulas.com

Client's Name/Nombre del cliente Client's Name/Nombre del cliente First Last
Client's Phone/Teléfono del cliente Client's Phone/Teléfono del cliente - ### - ### ####
Client's Email/ Correo electrónico del cliente
Doula's Name/Nombre de su doula Doula's Name/Nombre de su doula First Last
Baby's (or Babies'!) Birth Date/ Fecha de nacimiento del bebé: Baby's (or Babies'!) Birth Date/ Fecha de nacimiento del bebé: / MM / DD YYYY
Dates worked with doula/Fechas trabajadas con su Doula

Please circle the number that most closely reflects your opinion of the doula's contribution.
	1- Strongly Disagree	2- Disagree	3- Neither Disagree nor Agree	4- Agree	5-Strongly Agree	N/A Not Applicable
The doula acted in a professional manner/Su doula actuó de manera profesional	The doula acted in a professional manner/Su doula actuó de manera profesional1- Strongly Disagree	The doula acted in a professional manner/Su doula actuó de manera profesional2- Disagree	The doula acted in a professional manner/Su doula actuó de manera profesional3- Neither Disagree nor Agree	The doula acted in a professional manner/Su doula actuó de manera profesional4- Agree	The doula acted in a professional manner/Su doula actuó de manera profesional5-Strongly Agree	The doula acted in a professional manner/Su doula actuó de manera profesionalN/A Not Applicable
The doula was responsive to my needs/Su doula respondió a mis necesidades	The doula was responsive to my needs/Su doula respondió a mis necesidades1- Strongly Disagree	The doula was responsive to my needs/Su doula respondió a mis necesidades2- Disagree	The doula was responsive to my needs/Su doula respondió a mis necesidades3- Neither Disagree nor Agree	The doula was responsive to my needs/Su doula respondió a mis necesidades4- Agree	The doula was responsive to my needs/Su doula respondió a mis necesidades5-Strongly Agree	The doula was responsive to my needs/Su doula respondió a mis necesidadesN/A Not Applicable
The doula was responsive to my baby's/babies' needs/Su doula respondió a las necesidades de mi bebé/bebés	The doula was responsive to my baby's/babies' needs/Su doula respondió a las necesidades de mi bebé/bebés1- Strongly Disagree	The doula was responsive to my baby's/babies' needs/Su doula respondió a las necesidades de mi bebé/bebés2- Disagree	The doula was responsive to my baby's/babies' needs/Su doula respondió a las necesidades de mi bebé/bebés3- Neither Disagree nor Agree	The doula was responsive to my baby's/babies' needs/Su doula respondió a las necesidades de mi bebé/bebés4- Agree	The doula was responsive to my baby's/babies' needs/Su doula respondió a las necesidades de mi bebé/bebés5-Strongly Agree	The doula was responsive to my baby's/babies' needs/Su doula respondió a las necesidades de mi bebé/bebésN/A Not Applicable
The doula was knowledgeable about newborn care and characteristics/Su doula estaba bien informada sobre el cuidado y las características del recién nacido	The doula was knowledgeable about newborn care and characteristics/Su doula estaba bien informada sobre el cuidado y las características del recién nacido1- Strongly Disagree	The doula was knowledgeable about newborn care and characteristics/Su doula estaba bien informada sobre el cuidado y las características del recién nacido2- Disagree	The doula was knowledgeable about newborn care and characteristics/Su doula estaba bien informada sobre el cuidado y las características del recién nacido3- Neither Disagree nor Agree	The doula was knowledgeable about newborn care and characteristics/Su doula estaba bien informada sobre el cuidado y las características del recién nacido4- Agree	The doula was knowledgeable about newborn care and characteristics/Su doula estaba bien informada sobre el cuidado y las características del recién nacido5-Strongly Agree	The doula was knowledgeable about newborn care and characteristics/Su doula estaba bien informada sobre el cuidado y las características del recién nacidoN/A Not Applicable
The doula was able to answer my questions/Su doula pudo responder a mis preguntas	The doula was able to answer my questions/Su doula pudo responder a mis preguntas1- Strongly Disagree	The doula was able to answer my questions/Su doula pudo responder a mis preguntas2- Disagree	The doula was able to answer my questions/Su doula pudo responder a mis preguntas3- Neither Disagree nor Agree	The doula was able to answer my questions/Su doula pudo responder a mis preguntas4- Agree	The doula was able to answer my questions/Su doula pudo responder a mis preguntas5-Strongly Agree	The doula was able to answer my questions/Su doula pudo responder a mis preguntasN/A Not Applicable
The doula could explain the changes of the postpartum period/Su doula podría explicar los cambios del período posparto	The doula could explain the changes of the postpartum period/Su doula podría explicar los cambios del período posparto1- Strongly Disagree	The doula could explain the changes of the postpartum period/Su doula podría explicar los cambios del período posparto2- Disagree	The doula could explain the changes of the postpartum period/Su doula podría explicar los cambios del período posparto3- Neither Disagree nor Agree	The doula could explain the changes of the postpartum period/Su doula podría explicar los cambios del período posparto4- Agree	The doula could explain the changes of the postpartum period/Su doula podría explicar los cambios del período posparto5-Strongly Agree	The doula could explain the changes of the postpartum period/Su doula podría explicar los cambios del período pospartoN/A Not Applicable
The doula provided assistance, reassurance, and guidance during feeding/Su doula brindó asistencia, tranquilidad y orientación durante la alimentación	The doula provided assistance, reassurance, and guidance during feeding/Su doula brindó asistencia, tranquilidad y orientación durante la alimentación1- Strongly Disagree	The doula provided assistance, reassurance, and guidance during feeding/Su doula brindó asistencia, tranquilidad y orientación durante la alimentación2- Disagree	The doula provided assistance, reassurance, and guidance during feeding/Su doula brindó asistencia, tranquilidad y orientación durante la alimentación3- Neither Disagree nor Agree	The doula provided assistance, reassurance, and guidance during feeding/Su doula brindó asistencia, tranquilidad y orientación durante la alimentación4- Agree	The doula provided assistance, reassurance, and guidance during feeding/Su doula brindó asistencia, tranquilidad y orientación durante la alimentación5-Strongly Agree	The doula provided assistance, reassurance, and guidance during feeding/Su doula brindó asistencia, tranquilidad y orientación durante la alimentaciónN/A Not Applicable
The doula demonstrated good listening skills/Su doula demostró buenas habilidades para escuchar	The doula demonstrated good listening skills/Su doula demostró buenas habilidades para escuchar1- Strongly Disagree	The doula demonstrated good listening skills/Su doula demostró buenas habilidades para escuchar2- Disagree	The doula demonstrated good listening skills/Su doula demostró buenas habilidades para escuchar3- Neither Disagree nor Agree	The doula demonstrated good listening skills/Su doula demostró buenas habilidades para escuchar4- Agree	The doula demonstrated good listening skills/Su doula demostró buenas habilidades para escuchar5-Strongly Agree	The doula demonstrated good listening skills/Su doula demostró buenas habilidades para escucharN/A Not Applicable

Please circle the number that most closely reflects your opinion of the doula's contribution.
	1- Strongly Disagree	2- Disagree	3- Neither Disagree nor Agree	4- Agree	5-Strongly Agree	N/A Not Applicable
The doula was responsive to the needs of other family members/Su doula respondió a las necesidades de otros miembros de la familia	The doula was responsive to the needs of other family members/Su doula respondió a las necesidades de otros miembros de la familia1- Strongly Disagree	The doula was responsive to the needs of other family members/Su doula respondió a las necesidades de otros miembros de la familia2- Disagree	The doula was responsive to the needs of other family members/Su doula respondió a las necesidades de otros miembros de la familia3- Neither Disagree nor Agree	The doula was responsive to the needs of other family members/Su doula respondió a las necesidades de otros miembros de la familia4- Agree	The doula was responsive to the needs of other family members/Su doula respondió a las necesidades de otros miembros de la familia5-Strongly Agree	The doula was responsive to the needs of other family members/Su doula respondió a las necesidades de otros miembros de la familiaN/A Not Applicable
The doula was able to provide information regarding resources such as lactation support, childcare, etc./Su doula pudo proporcionar información sobre recursos como apoyo para la lactancia, proveedores de guardería, etc	The doula was able to provide information regarding resources such as lactation support, childcare, etc./Su doula pudo proporcionar información sobre recursos como apoyo para la lactancia, proveedores de guardería, etc1- Strongly Disagree	The doula was able to provide information regarding resources such as lactation support, childcare, etc./Su doula pudo proporcionar información sobre recursos como apoyo para la lactancia, proveedores de guardería, etc2- Disagree	The doula was able to provide information regarding resources such as lactation support, childcare, etc./Su doula pudo proporcionar información sobre recursos como apoyo para la lactancia, proveedores de guardería, etc3- Neither Disagree nor Agree	The doula was able to provide information regarding resources such as lactation support, childcare, etc./Su doula pudo proporcionar información sobre recursos como apoyo para la lactancia, proveedores de guardería, etc4- Agree	The doula was able to provide information regarding resources such as lactation support, childcare, etc./Su doula pudo proporcionar información sobre recursos como apoyo para la lactancia, proveedores de guardería, etc5-Strongly Agree	The doula was able to provide information regarding resources such as lactation support, childcare, etc./Su doula pudo proporcionar información sobre recursos como apoyo para la lactancia, proveedores de guardería, etcN/A Not Applicable
The doula was able to suggest coping strategies that were helpful/Su doula pudo explicar algunas estrategias y recursos útiles para afrontar el periodo postparto	The doula was able to suggest coping strategies that were helpful/Su doula pudo explicar algunas estrategias y recursos útiles para afrontar el periodo postparto1- Strongly Disagree	The doula was able to suggest coping strategies that were helpful/Su doula pudo explicar algunas estrategias y recursos útiles para afrontar el periodo postparto2- Disagree	The doula was able to suggest coping strategies that were helpful/Su doula pudo explicar algunas estrategias y recursos útiles para afrontar el periodo postparto3- Neither Disagree nor Agree	The doula was able to suggest coping strategies that were helpful/Su doula pudo explicar algunas estrategias y recursos útiles para afrontar el periodo postparto4- Agree	The doula was able to suggest coping strategies that were helpful/Su doula pudo explicar algunas estrategias y recursos útiles para afrontar el periodo postparto5-Strongly Agree	The doula was able to suggest coping strategies that were helpful/Su doula pudo explicar algunas estrategias y recursos útiles para afrontar el periodo postpartoN/A Not Applicable

What was the most valuable aspect of your doula's support?
¿Cuál fue el aspecto más valioso del apoyo de su doula?
How could your doula improve their support?
¿Cómo podría su doula mejorar el apoyo que proporciona?
Is there anything else you would like us to know?
¿Hay algo más que le gustaría que supiéramos?
Sign in the box below to indicate that your responses reflect your honest opinions about the postpartum doula services you received.
Firme en el cuadro a continuación para indicar que sus respuestas reflejan sus opiniones honestas sobre los servicios de doula posparto que recibió.

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