Student Health Services Survey

1. Did you schedule an appointment for your visit?
(If you came more than once, did you schedule appointments most of the time?)

Did you schedule an appointment for your visit? (If you came more than once, did you schedule appointments most of the time?) Yes

2. How long did you wait to be seen?

How long did you wait to be seen? Less than 5 Minutes

5-15 Minutes

15-30 Minutes

30-45 Minutes

Greater than 45 Minutes

Other (please specify)

3. Please rate your interactions with the following people:

	Excellent	Good	Fair	Poor	N/A
Nurse Practitioner	*Please rate your interactions with the following people: Nurse Practitioner Excellent	Nurse Practitioner Good	Nurse Practitioner Fair	Nurse Practitioner Poor	Nurse Practitioner N/A
Nursing Students	Nursing Students Excellent	Nursing Students Good	Nursing Students Fair	Nursing Students Poor	Nursing Students N/A
Student Receptionist	Student Receptionist Excellent	Student Receptionist Good	Student Receptionist Fair	Student Receptionist Poor	Student Receptionist N/A

Please comment on interactions (be specific):

4. In regard to your expectation for service, would you say that:

In regard to your expectation for service, would you say that: SHS Exceeded Your Expectations

SHS Met Your Expectations

SHS Did Not Meet Your Expectations

If not, please comment (be specific):

5. Please rate the following

	Excellent	Good	Fair	Poor	N/A
Convenience of Scheduling	*Please rate the following Convenience of Scheduling Excellent	Convenience of Scheduling Good	Convenience of Scheduling Fair	Convenience of Scheduling Poor	Convenience of Scheduling N/A
Convenience of SHS Location	Convenience of SHS Location Excellent	Convenience of SHS Location Good	Convenience of SHS Location Fair	Convenience of SHS Location Poor	Convenience of SHS Location N/A
Convenience of Days Open	Convenience of Days Open Excellent	Convenience of Days Open Good	Convenience of Days Open Fair	Convenience of Days Open Poor	Convenience of Days Open N/A
Convenience of Hours Open	Convenience of Hours Open Excellent	Convenience of Hours Open Good	Convenience of Hours Open Fair	Convenience of Hours Open Poor	Convenience of Hours Open N/A

Please comment on how we might improve these areas (be specific):

6. Do you feel the provider addresses your concerns?

Do you feel the provider addresses your concerns? Not at All

Somewhat

Very Much So

If not, please comment (be specific):

Student Health Services
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