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Survey of Patient Satisfaction

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

1. Please check all categories to describe you.
Male
Female
LGBTQ
Freshman
Sophomore
Junior
Senior
Law
International/exchange student
NCAA athlete

Please rate the following:

Dial-A-Nurse appointment scheduling process:

Excellent Very Good Good Fair Poor N/A

Helpfulness and courtesy of SHC staff:

Excellent Very Good Good Fair Poor N/A

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

Explanation of what was done for you at the 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

Your visit overall:

Excellent Very Good Good Fair Poor N/A

Helpfulness of URWell website:

Excellent Very Good Good Fair Poor N/A

Helpfulness of after-hours nurse advice phone service:

Excellent Very Good Good Fair Poor N/A

Is this your first visit to the Student Health Center (SHC)?

Yes
No

Did you see the doctor today?

Yes No

Did you see the nurse today?

Yes
No

Is the SHC conveniently located?

Yes
No

Was the length of your visit longer than expected?

Yes
No

Would you recommend the SHC to a friend?

Yes
No

Comments and/or suggestions:

Optional:

So that we may follow up on your comments, please provide the following information. It will remain confidential and within the Student Health Center.

Name:

Email: