Supporters of Darley Birth Centre have until Sunday to make their views known.
Matlock Hospitals League of Friends is urging everyone to have their say on the threatened unit’s future.
Group member Alice Lockett said “We really need as many people as possible to contact the PCT regarding Darley.
“Lets show the PCT that Darley is a much valued local service and that it would be detrimental to the community of Matlock, Darley Dale and further afield if we lost it.”
Copies of the questionnaire can be found in the Mercury office, at Manor Pharmacy and in Peli Deli in Matlock and Wirksworth.
A link to the online version can be found at the League’s website.
Health chiefs and campaigners debated the controversial plans at Bakewell Town Hall last Friday during a public meeting.
NHS Derbyshire County is reviewing the future of the facilities as part of plans to cut costs amid increasing demand for health services.
But the proposals have sparked outrage among residents and campaigners who have been battling to save the facilities since the review was launched in May.
The meeting was attended by members of a number of organisations, including Chesterfield Royal Hospital, North Derbyshire Clinical Commissioning Group and Matlock Hospital League of Friends.
It was organised by the county council’s improvement and scrutiny committee which listened to the arguments for and against and will come to a decision on the planned closure before making a recommendation to the PCT.
The League argue the centre has not been promoted properly and to close it would be to deny women in rural Derbyshire the choice of where to have their babies
But health bosses say Darley is too expensive and only low-risk women can give birth there, meaning the least complicated births are costing the most.
Gill Farrington, chairman of the committee, said: “It will be a difficult decision to make. Some people will say it’ll be the right decision, some people will say it’ll be the wrong decision.”
Health bosses will decide the future of the birth centres at a meeting in December.