East Wing Visitor Feedback form

Your name:............
Your email address:

Have you suffered a miscarriage? Yes No

If 'yes' how many? One two three four five six seven eight nine ten more then ten (if more then ten..how many?)

Did you find the medical profession in general to be
Very caring/helpful Indifferent Cold/rude
Well informed Ignorant regarding your feelings Other
If 'other' how would you describe your experience?

Please explain any good or bad experiences you had in so far as things people(medical or general public)did or said.

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Will you visit Eastwing again? Yes No Maybe

Will you tell others about this site? Yes No Maybe

Do you have a website? Yes No

If yes will you link to Eastwing? Yes No