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    ICAN of Phoenix Member Survey

    In order to protect the safety and culture of our ICAN of Phoenix group, we ask that each member of our private community fill out the following survey.  This survey will help us understand the unique needs of our group, will give us a better understanding of our collective experiences and will help us ensure that each member is there to recieve or provide cesarean awareness and birth support. 

    The fields marked with an * are mandatory and exist to ensure the security of the group.  All other fields are optional, but will help us gain a better understanding of the needs and experiences of our members.

    Thank you for your understanding and your participation.


    Your Birth Experience


    Care Provider Recommendations

    *Optional*
    We would like to know if you have any prenatal/postnatal care providers in the greater Phoenix area that you would recommend based on your direct experience working with them.  By listing the names below, you are stating that you have used that individual for prenatal or postnatal care and would recommend their services to others.  The information collected in this field may be used for the ICAN of Phoenix Resource Directory; your recommendation will remain anonymous.  Each field is optional.

    Are you a Care Provider?

    If you would like your services to be considered for our resource page, please fill out the information below.
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    Contact Information

    Periodically, ICAN of Phoenix may send emails or physical mail to communicate ICAN news.  If you are interested in recieving these communications, please fill out the information below accordingly.
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