Optometry Issue Report:
Please use this form to report issues with classrooms, study spaces, pre-clinic, and Marillac Hall in general. Please fill out as much as possible. If this is an emergency, please contact Nick Palisch via email or cell phone (314-210-0663) *THIS FORM IS NOT FOR USE REPORTING ISSUES IN THE PATIENT CARE CENTER, LINDELL EYE, OR ESL.*
First and Last Name:
Date of Issue:
Location of Issue:
Type of Issue (Select all that apply)
Please describe problem:
Any other information you feel is relevant:
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