Prenatal Survey – Survey 2 (Post)

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Thank you for taking the time to complete this final survey. The survey below is our post survey. You will receive more books and information from us after you complete this survey. Please be sure to complete all of the required fields (marked with an asterisk). Your information will be kept entirely confidential.

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Today’s Date:*

First Name:*

Last Name:*

Address:*

Address 2:

City:*

State:

CONNECTICUT

ZIP Code:*

County:*

Home/Mobile Phone:*

Email*

What year were you born?*

Location of care:*

1. A baby is ready to learn from birth.*

2. Parents are a baby’s first teachers.*

3. Brain development is greatest in a persons first 3 years of life.*

4. Sharing books and reading with a baby stimulate the brain and language skills.*

5. Talking and reading increase a child's vocabulary (words the child knows).*

6. Screen time (such as TVs, phones, tablets or computers) is not recommended for children under age 2.*

Before submitting your form, please make sure all required fields are completed.

Once you click “Submit,” you should see a message that says “Thank you for Completing Our Survey!” This confirms that your request went through.

If you do not see the “thank you” message, your request was not submitted successfully. Please double-check the form and try again.

Thank you for your time and care in completing our survey.

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Prenatal Survey – Survey 2 (Post)

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