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We Care What You Think!

NOTE:  All information is strictly confidential

Date of Appointment:    (MM/DD/YYYY)

  Appointment was with:  

How did you hear about the Student Health Center?

Please select the appropriate answer in each area:

                                        Excellent     Good      Fair      Poor

Appointment Availability                                   

Waiting Room Time                                          

Courtesy                                                             

Quality of Service                                                

Quality of Care                                                   

   What went well?

   What could we do better?

Thank you for taking time to complete this survey!      

The Director will review your comments and forward them to any other appropriate staff members.

Please press "Submit" to send your responses.  Press "Reset" to start over.   

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