UC Irvine Student Health General Feedback Form

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We would like to hear from you about areas of improvement that would enhance our services and your experience as a patient here at the Student Health Center. We are interested in hearing suggestions for improvement, areas of service shortfall, and general overall feedback.

Q1. Date

YYYY

Q2. Name

Q3. Feedback:

(Please specify with as much detail as possible, the situation, staff members involved, etc)

Q4. Check if you believe that this issue relates to:

FERPA privacy laws (enrolled student)

HIPAA privacy laws (non-student patient)

Q5. If you would like someone to contact you regarding this issue, please leave your Name, Student ID, Email, or Phone Number

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