Peer Breastfeeding Program Feedback

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Program Feedback

Peer breastfeeding counselor's name

How often did you speak with your counselor?

What kind of information did you get from your counselor?

Is there more you would like to know about breastfeeding?

What would make the peer breastfeeding counselor program better?

Do you feel like the information or support you got from your peer breastfeeding counselor helped you reach your breastfeeding goals?

Participant Information

Mother's name

Baby's name

Baby's birth month and day

Month

Day

Year

WIC Household ID

8-digit number, if known

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