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
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