SE Student Health Survey
This survey is to be filled out by individuals who have accessed Student Health Services and would like to communicate how their experience effected them. Please be thoughtful in your responses and we thank you for your time and candidness.
How much of an impact did your illness have on your academic performance?
Are You:
How Are We Doing?
Please select how well we are doing in the following areas: 5=Great 4=Good 3=Okay 2=Fair 1=Poor
Ability to get in to be seen:
Hours Center is open:
Convenience of Center's location :
Prompt return of calls :
Time in waiting room :
Time in exam room :
Waiting for tests to be performed :
Waiting for tests results :
Check the name of your care provider:
Medical Professionalism
Please select how well the care provider is doing in the following areas: 5=Great 4=Good 3=Okay 2=Fair 1=Poor
Listens to you:
Takes enough time with you:
Explains what you want to know:
Gives you good advice and treatment:
Friendly and helpful to you:
Answers your questions:
All Other Areas
Please select how well we are doing in the following areas: 5=Great 4=Good 3=Okay 2=Fair 1=Poor
Office staff are friendly and helpful to you:
Office staff answer your questions:
What you pay for services:
Explanation of charges:
Collection of payment/charges:
Neat and clean facility:
Ease of finding where to go:
Comfort and safety while waiting:
Privacy:
Keeping my personal information private:
The likelihood of referring other students to us:
Do you consider this center your regular source of care?
What do you like best about our center?
Your answer
What do you like least about our center?
Your answer
Suggestions for improvement?
Your answer
Academics
Please select how well the care provider is doing in the following areas: 5=Great 4=Good 3=Okay 2=Fair 1=Poor
How well did we identify an appointment time that worked with your class schedule?
To what extent did your treatment through Student Health Services speed your return to the classroom?
If you would like our staff to contact you, please include your name and phone number so someone may contact you:
Your answer
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