Guy’s and St Thomas’ NHS Foundation Trust

Gynaecology Pregnancy Loss Experience Survey

We are very sorry for your loss, and we appreciate that this is an extremely difficult time for you.

This questionnaire is for women and their partners that have experienced the loss of their baby/babies during pregnancy. Please complete as much or as little of the form that you are able to. Some questions may not be relevant to your experience. 

Please tick the relevant box for each question and write any comments you might have.  All information given will remain anonymous unless you wish to provide your contact details at the end of this questionnaire.  If you would like to discuss any aspects of your care, please contact the bereavement midwives nurse.