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Maternal Journal

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* 1. Which Maternal Journal group did you take part in - name and dates

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* 2. What is your gender identity?

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* 3. Do you identify as transgender (or another non-cisgender identity)?

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* 4. What is your sexual orientation?

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* 5. What is your ethnic identity? (Select all that apply.)

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* 6. Do you identify as disabled/consider yourself to have a disability

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* 7. Is english your first language?

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* 8. What language(s) do you speak at home?

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* 9. Do you identify with any of the following religions? (Please select all that apply.)

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* 10. Are you a parent or caretaker of children?

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* 11. Are you a caretaker of adults?

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* 12. What age are you?

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