Greetings! We are 4th year students taking up Bachelor of Science in Accountancy in Lyceum of the Philippines University- Cavite. We are currently conducting our Feasibility Studies about Maternity and Pediatric Hospital.

As part of this, we have to conduct a survey to gain information about Maternal Health Services. We would appreciate it if you will participate in this survey.

Kindly answer it honestly.

1. Please indicate your postal code below so that we can group child care needs by area: postal code: ______ ______

2. In general, do you think that families in your community have access to an adequate supply of child care services?

Yes No Don’t know

3. Do you have any children or infant in your household?

Yes No

4. How many are they?

1-2 2-4 5-6 More than 6

5. Which age groups your child belongs to?

Birth-11 months 12-23 months (1 year old) 2-4 years 5-9 years 10-14 years

6. Is your child male or female?

Male Female

7. What is your relationship to the child?

Mother Father Grandmother Grandfather Aunt Uncle

8. Where do you go first when your child/kids got sick?

Relatives Friends Doctors Others: __________________________

9. Where do you usually go when your child is sick or needs health services?

Clinic Health centre Private Hospital Public Hospital Others: ___________________________

Name: __________________________________ Date: ______________________ Gender: _________ Age: _____ Municipality: _________________

10. Who's the one making the decisions where to consult?

Husband Self Both Others: __________________________

11. How did you know the hospitals in your vicinity?

Referral by doctors Referral by friends Self-search Media

12. When do you consult the doctor for the child's health?

General-check up If Sick If required Others: __________________________

13. How many times do you consult the doctor?

Once a year Every month Twice a month Others: ___________________________

14. In case of emergency, where will you bring your child ? Clinic Private Hospital Public Hospital Others: ___________________________

15. Do you consider the aesthetic setting of the hospital/clinic?

Yes No

16. What is your monthly family income?

2000-5000

5000-10000 10000-20000 20000-50000 50000 Above

17. What do you consider in choosing the hospital for providing your child's health care?Please Rank 1-4 (1 as the highest) Environment Doctor Facilities Hospital Rate

18. Do you consider Health care benefits such as Phil Health?

Yes No

19. Do you have any other health care benefits other than Phil Health? Yes No

If Yes, What? __________________________

Ma'am these are the additional questions that I may include in the other survey questions.

Additional Questions:

1. Who's the one making the decisions where to consult?

Husband Self Both Others: _____________________________

2. Do you consider Health care benefits such as

Phil Health?

Yes No

3. Do you have any other maternity health care benefits other than Phil Health?

Yes No

If Yes, What? __________________________

4. Do you save money for your pregnancy?

Yes No

5. How much money do you save for the future Delivery?

2000-50005000-1000010000-2000020000-5000050000 Above