Feedback your Pregnancy Outcome

Name

Date of Birth

Phone(Optional)

Email(Optional)

Which location did you attend?

If other, Please Specify

What was baby(s) date of delivery?

What was the sex / gender of your baby?

Did you opt to screen for Down's syndrome & other chromosomal abnormalities??

If yes, what screening di you opt for?

Did you screen high risk?

Was amniocentisis or chorionic villus sampling performed?

What was the result?

Were any abnormailities detected?

Can you please give details of any abnormality detected

Additional Comments