2023 Annual First Breath Provider Survey

Individual Provider Experience

Thank you so much for taking the time to complete the Annual First Breath Provider Survey. Your feedback is incredibly valuable and we will use your input to improve the services we provide.

Please do not use the "back" button on your browser, as this can cause errors with the survey. Use the buttons at the bottom of the survey to move forward and backward within the survey.

As a "thank you," we will randomly choose 20 people to receive a $10 gift card. If you're interested in being entered into the drawing, please provide your information at the end of the survey.

Your contact information will NOT be linked to your survey responses.

1. Which of the following duties do you carry out for the First Breath program? (check all that apply) *This question is required.

Direct Services (talk to pregnant people about their tobacco use and the First Breath program)
Handle First Breath materials (give out or stock gifts, workbooks, or promo material)
Handle referral forms (either fill out or submit)
Supervise the implementation of First Breath at my agency
Other - Write In Please enter an 'other' value for this selection.