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申込

選択中の手続き名： 妊娠中の方へのアンケート　英語版

問合せ先

開く
説明
Please answer the following questions to give you better informations and consultation.
受付時期
2024年4月24日14時20分 ～ 随時
問い合わせ先
豊橋市保健所こども保健課
電話番号
0532-39-9160
FAX番号
メールアドレス
kodomo-sinsei@city.toyohashi.lg.jp

必須
必須
Tel
必須
Please write the number of your maternal and Child Health
Handbook No.
必須
About the latest pregnancy
Length of pregnancy wks
1-2．必須
About the latest pregnancy（Check all that apply）
1-2．

2．必須
Do you receive the prenatal checkup regularly?
※Name of the hospital
2．


3．必須
Do you decide the hospital where you will deliver a baby?
※Name of the hospital
3．


4．

Please answer about the period after childbirth- 4 months.
4-1．必須
Who do you think will do housework and childrearing together
with you?
4-1．


4-2．

How often your husband or partner will have time to do housework and
raising your child after the childbirth?
Period必須
Period

Types（Check all that apply）必須
Types（Check all that apply）


How long必須
How long

What will he help（Check all that apply）必須
What will he help（Check all that apply）

4-2．必須
How often your mother will support you?
4-2．

Period必須
Period

How long必須
How long

What will she help（Check all that apply）必須
What will she help（Check all that apply）

4-2．必須
How often your father will support you?
4-2．

Period必須
Period

How long必須
How long

What will he help（Check all that apply）必須
What will he help（Check all that apply）

4-2．必須
How often your mother in law will support you?
4-2．

Period必須
Period

How long必須
あてはまるものを選択してください。
How long

What will she help（Check all that apply）必須
What will she help（Check all that apply）

4-2．必須
How often your father in law will support you?
4-2．

Period必須
Period

How long必須
How long

What will he help（Check all that apply）必須
What will he help（Check all that apply）

4-2．必須
How often your sibling will support you?
4-2．

Period必須
Period

How long必須
How long

What will he/she help（Check all that apply）必須
What will he/she help（Check all that apply）

4-2．必須
How often your aunt will support you?
4-2．

Period必須
Period

How long必須
How long

What will she help（Check all that apply）必須
What will she help（Check all that apply）

4-2．必須
How often your uncle will support you?
4-2．

Period必須
Period

How long必須
How long

What will he help（Check all that apply）必須
What will he help（Check all that apply）

4-2．必須
How often your friends will support you?
4-2．

Period必須
Period

How long必須
How long

What will he/she help（Check all that apply）必須
What will he/she help（Check all that apply）

4-2．必須
How often the person will support you?
4-2．

Period必須
Period

How long必須
How long

What will he/she help（Check all that apply）必須
What will he/she help（Check all that apply）

5．

Which following face suits your feeling now about the childbirth and
childrearing? Please choose the number.
5．
5．必須
5．

6．必須
Do you have any concerns or worries at the moment?
(Check all that apply)
6．


6-1．必須
For those who answered "my health condition",
please choose one of the followings.
6-1．

Please write in detail about the question no. 6

入力文字数： 0/ 200

7．必須
It's better to ask us about any concerns during pregnancy so
that you make your life easier after childbirth.
Do you want to have a counseling with public health nurse
or midwife?
7．

※

If you answer yes to the question no.7,
we will contact you.
We appreciate your understanding if we contact you.

※

Please answer the following questions to make a city
where you can have a baby and rearing a child easier.
8．必須
What do you think about Public Health Center,
Child Health Division (Pregnancy, Childbirth, and Childrearing
Consultation Counter)?
8．


9．必須
What do you think about COCONICO (Pregnancy, Childbirth,
and Childrearing Consultation Counter)?
※COCONICO↓
https://www.city.toyohashi.lg.jp/41331.htm
9．


10．必須
Did you go or do you have a plan to go to the following
facilities using as a consultation during pregnancy?
(Check all that apply)

CHIIKI KOSODATE SHIEN CENTER↓
https://www.city.toyohashi.lg.jp/19066.htm
10．

11．必須
Do you have a plan to go to the following facilities
using as a consultation during pregnancy?
(Check all that apply)

※1 COCONICO CIRCLE↓
https://www.city.toyohashi.lg.jp/41329.htm
※2 TSUDOINO HIROBA↓
https://www.city.toyohashi.lg.jp/41330.htm
11．

入力中のデータを一時保存・読み込み

【申込データ一時保存、再読込み時の注意事項】

  • ・添付ファイルは一時保存されません。再読込み後は、必要に応じて、ファイルを添付し直してください。
  • ・パソコンに一時保存した申込データはパソコンで閲覧・加筆・修正することはできません。
  • ・システムに読込む場合は一時保存した手続きの画面でしか読込めませんので、ご注意ください
  • ・入力中の申込データをパソコンに一時保存しますので、保存した申込データの取扱いは、申請者の責任において管理をお願いします。

「入力中のデータを保存する」では申込みの手続きが完了しておりませんのでご注意ください。

  • ※入力中の申込データをパソコンに一時保存します。

  • ※一時保存した申込データを再度読み込みます。