Sidelines Survey - Sidelines National Support Network

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Sidelines Survey

Please Take Our One Minute Survey!

What is your primary pregnancy complication?
Preterm labor
Incompetent cervix/cerclage
Multiple gestation
Placenta Previa, Placenta Abruptio, PIH, PROM
All others/special condition

What types of treatments are you receiving (check all that apply):
amniocentesis
complete bed rest
modified bed rest
cerclage
home uterine activity monitoring
hospitalization
IV hydration therapy
ultrasound

Medications (check all that apply):
heparin pump
indocin
mag sulfate
nifedipine
procardia
terbutaline/breathine
terbutaline pump

What type of health care provider are you seeing on a regular basis?
General practitioner
OB/GYN
Midwife
Perinatologist
Other

How often do you use the internet?
Once a week or less
Several times per week
Every day
Several times per day

Are you using the internet to find out information about your pregnancy condition?
Yes
No

If yes, how reliable would you rate the information that you are finding?
Extremely reliable: I plan to discuss several things with my health care provider
Mostly reliable: I have found mostly good information
Somewhat reliable: I have found some good and some questionable information
Not Reliable: I don't trust any of the information I have found on the internet

Does your health care provider have the ability to communicate with youover email?
Yes
No

If no, if available, would you like the ability to communicate with yourhealthcare provider over an internet site that provided secure email?
Yes
No

What things would you like to communicate to your healthcare providerover email (check all that apply):
Scheduling or changing appointments
Problems with treatment
Refilling a prescription
Communicating with a nurse in the office
Non-urgent issues
Urgent issues
Test results
Other:

Do you think being able to communicate with your health care providerover email would cut down on phone calls to their office during normalbusiness hours?
Yes
No
Not Sure

Would you feel more comfortable emailing your health care providerinstead of phoning about non-urgent issues on the weekends and holidays?
Yes
No
Not Sure

Assuming you could fill out a form in a private and secure internet location, would you be willing to volunteer to do a high-risk pregnancy assessment?

Yes
No

If yes, please indicate email address.

Thanks for your input!

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