Congratulations on the upcoming addition to your family! We are very excited to support you as you enter this new part of your life.
As part of this program, we will send you 2-3 care messages/week via text during your pregnancy. This program does not replace your doctor’s care; rather, it is intended as a helping hand.
To make sure we send information that will be most helpful to you, we’d like to get to know you better.
Please fill out this quick survey. Your information will be completely private and will not be shared or used for any other purpose.
Questions marked with an asterisk (*) are required
(Check all that apply)
These health conditions can affect your health and the health of the baby. Make sure your pregnancy provider knows about all your health conditions and your medications.
There’s no judgement here. The more you tell us, the better support we can give you. We promise we won’t share your answers with anyone.
(for example, marijuana, cocaine, meth, heroine, opioids, ecstasy)
We would like to know how you are feeling. Please check the answer that comes closest to how you have felt IN THE PAST 2 WEEKS, not just how you feel today.
Over the past 2 weeks, how often have you been bothered by any of the following problems?
If you feel this way, we can point you to resources that can help you. We promise we won’t share your answers with anyone.
Gender
Your responses are confidential. We only ask because your gender identification can affect the kind of support you need in pregnancy.
Race and Ethnicity
Which of the following best describes you? (Select all that apply)
It’s OK if you’d prefer not to say. We only ask because your ethnicity can affect the kind of support you need in pregnancy.
This text program is not meant to replace regular medical care provided by your doctor, but to enhance the care plan from your provider. Be sure to visit your provider regularly.
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