Virtual Guest Book | WOMB Initiative

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Please sign our Nursing Nook virtual guest book and answer a short survey

Demonstrating community need and satisfaction helps WOMB secure funding for operating our pop-up nursing nook and ensure community sponsors the impact of the nook's success.

See below to sign our guest book and complete a short 5-question experience survey.

www.wombinitiative.org/nursingnook

First name

Last name

Place of Residence Zip Code

How did you use the Nursing Nook today? (check all that apply)

Quiet place to feed my baby

Changing a diaper

Playpen/playspace

Took some resource information

Other

Do you benefit from or qualify for financial assistance?

Yes

Prefer not to answer

Do you find this Nursing Nook to be a helpful community resource?

Yes

Prefer not to answer

Do you need any community resources that were not available here today?

Yes

Prefer not to answer

Health Insurance Coverage Status (Yourself & children)

What event did you utilize the nook at?

Share about your breastfeeding/infant feeding journey below:

Please leave your email address if you would like to join our newsletter mailing list. We promise not to share your information or send you too many emails. We value your input and welcome continuous improvement suggestions!

You may share my story anonymously

Thank you for sharing.

877-357-WOMB (9662)

74 Cottage st suite 4 Littleton, NH 03561

Nonprofit Status:501 (c)3 Public Charity

EIN: 871878527

Checks payable to: The Women of the Mountains Birth Initiative

Contact Person: Funding Committee Chair-Kailene Jones, MPH

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