1. Which of the following best describes your current situation? *
Expecting a baby for the first time Expecting again Planning on becoming pregnant in the next 6-12 months Other
If other, please provide details
2. Do you have private health insurance? *
Yes No Other
If other, please provide details
2a. How important do you think private health insurance during pregnancy is? *
Essential when pregnant Nice to have, but not essential Little or no benefit for expecting families Other
If other, please provide details
2b. If you are expecting have you chosen to birth at a public or private hospital and why?
Public because Private because Not expecting
Please provide reason
3. How would you usually obtain information about pregnancy health? Choose one or more options *
If other, please provide details
4. Do you have any history of serious illness in your immediate or extended family? eg heart disease, auto immune disease, cancer, leukemia, diabetes? *
Don't Know No Yes
If yes, please provide details
5. How would you describe your knowledge of cord blood collection? *
Never heard of it / don’t know the benefits Heard about it but don’t understand the benefits Fully understand the benefits
6. How would you best describe your knowledge on the difference between public and private cord blood banking? *
I know the difference between public & private cord blood collection I have some knowledge on the difference between public & private cord blood collection I do not know the difference between public & private cord blood collection
6a. If you had the option to bank your baby's cord blood privately or for public use which are you most likely to choose? *
Private – I would prefer to bank my baby’s cord blood stem cells for my child’s use only Public – I would prefer to donate my baby’s cord blood stem cells for public use Don't Know
Please expand on why you chose this option?
7. Have you seen or heard information in the media (newspapers, magazines, television, radio) on Cord Blood Banking recently? *
No Yes
If yes, what was your opinion about it?
8. What do you think is the MOST important reason to bank your baby's Cord Blood? *
Peace of mind by providing future healthcare possibilities for my baby Helping someone else’s family through public donation To support scientific research in the area of stem cells All of the above Don’t know Other
If other, please provide details
9. How likely are you to consider storing your baby's cord blood in the future? *
Very likely Likely Unlikely Don't Know
Comments
10. Would you be more likely to consider cord blood banking if it was subsidised by your Health Insurer?
Yes, definitely Maybe No
11. What would be your most preferred option(s) to pay for Cord Blood Banking? Choose one or more options
If other, please provide details
12. What further information would you like to receive about cord blood banking? Choose one or more options *
If other, please provide details
Thank you. We value your opinion and appreciate the time you have spent in completing our survey. -------MORE TEXT TO ADD HERE----------- please complete your details below
Name
Email *
Phone
Postal Address (by completing this you may receive information by post)
