Survey of Patient Satisfaction

Thank you for helping us evaluate our service by completing this survey!

Please rate the following:
Your visit overall:
Excellent	Very Good	Good	Fair	Poor	N/A
The Dial-a-Nurse appointment scheduling process:
Excellent	Very Good	Good	Fair	Poor	N/A
The helpfulness and courtesy of the SHC staff:
Excellent	Very Good	Good	Fair	Poor	N/A
The professional skills (thoroughness, carefulness, competence) of the health care provider:
Excellent	Very Good	Good	Fair	Poor	N/A
The personal manner (respect, friendliness, sensitivity) of the health care provider:
Excellent	Very Good	Good	Fair	Poor	N/A
The respect given to you regarding your gender, race, ethnicity, sexual orientation, economic status, disability, religion, or age:
Excellent	Very Good	Good	Fair	Poor	N/A
The explanation of what was done for you at the visit:
Excellent	Very Good	Good	Fair	Poor	N/A
The effectiveness of your care:
Excellent	Very Good	Good	Fair	Poor	N/A
The length of time you waited at your visit:
Excellent	Very Good	Good	Fair	Poor	N/A
The comfort, safety, and security of the SHC facilities:
Excellent	Very Good	Good	Fair	Poor	N/A
The location of the SHC:
Excellent	Very Good	Good	Fair	Poor	N/A
Helpfulness and availability of educational materials: (patient education handouts, etc.)
Excellent	Very Good	Good	Fair	Poor	N/A
Helpfulness of SHC website:
Excellent	Very Good	Good	Fair	Poor	N/A
Comments and/or suggestions:

Optional: So that we may follow up on your comments, please provide the following information: Name: Email: Phone:

1. Please check all categories to describe you.
Male Female LGBTQ	Freshman Sophmore Junior Senior Law/Grad	International/Exchange Student NCAA Athlete
2. Is this your first visit to the Student Health Center (SHC)? Yes No
3. Which health care provider did you see? MD Nurse Practitioner Nurse
4. Would you recommend the SHC to a friend? Yes No
5. Did we meet your expectations today? Yes No