Thank you for agreeing to participate in our user satisfaction survey. Please take a few minutes to respond honestly and thoroughly. Your responses are important to us and the improvement of our services.

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1. Your sex:

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2. Your racial/ethnic background: (mark only one)

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3. Were the Student Health Center hours convenient for you?

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4. The Front Desk Reception was:

  Strongly Disagree Disagree Neutral Agree Strongly Agree
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Pleasant
Helpful

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5. Who did you see during your visit to the Student Health Center? (Mark all that apply.)

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6. Please rate the following statements:

  Strongly Disagree Disagree Neutral Agree Strongly Agree N/A
The attending professional was interested in me as an individual.
The advice and treatment I received seemed appropriate.
The instructions for follow-up care were clearly explained.
My questions, problems, and issues were addressed satisfactorily.
The educational materials received (if any) were helpful.

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7. Please rate the following statements:

  Strongly Disagree Disagree Neutral Agree Strongly Agree
Overall, I had a good experience
I would return to the Student Health Center for assistance in the future.

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8. Faculty, staff, and student parents are unable to obtain information about any student's health records without the student's consent. Were you aware that all information obtained from you by the Health Care staff is confidential?

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9. Please list the top three health concerns of Longwood students:

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10. Please list your top three health concerns:

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11. What additional services would you like to see made available at the Longwood University Student Health Center?

Adapted from the University of Mary Washington Student Health Center, Spring 2010.

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