Print a Hospital Letter

If you are planning to have a hospital birth and would like to provide feedback to your hospital about your birth preferences, please fill out the following questionnaire. It should take less than 10 minutes of your time. Once you submit the form, you will be able to preview, edit and print the letter to be signed and mailed to the hospital. (Note: A copy of the letter will be emailed to us for statistical purposes. You will not be on a mailing list or receive spam).

Step 1: Preliminary Information

Fields marked * are required.

What is the fifth letter of the alphabet?