Short Survey

 In
0
0
Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Short Survey
Hello!
My name is Lili, and I recently created a website about my motherhood experiences.  I have been through a lot to achieve the coveted title of "Mom", and I obviously feel the continueing effects of it all to this day.  I feel complled to tell my story, both in  lectures I give about my past and in the pieces I write for my website about my current experiences.
I would like to invite you to share in my life, as well as share your life experiences with me.

I also need your help to improve my website - I would really appreciate it if you could take a few minutes and answer the following questions.  You may always contact me in the future through my website.

Thank you so much for your willingness to help,
Lili
lilmoms.com
Sign in to Google to save your progress. Learn more
* Indicates required question
I'd like to get to know you better - which best describes you? *
You may choose several options, and add any details in the "other" open box.
Required
What is the biggest problem you are facing today in your parenthood? *
If you are a professional working with many parents, you may detail your biggest problem professionally, or the problem you most encounter with other parents.
Your answer
I would like to better serve you.  Use the checkboxes below, and tick off which areas are of interest to you.  You're more than welcome to use the "other" open box to detail more areas of interest. *
I will make sure to include in my website and emails content that is of interest to you.  I'm always reachable through my website, so make sure to let me know if you have any further inputs in the future.  I'm listening.
Required
First Name *
Your answer
Email *
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms
 
 
 
Help and feedback
  •  
     
     
    Contact form owner
  •  
     
     
    Help Forms improve
  •  
     
     
    Report