In order to continue improving, we want to hear about your experience at The Ashe Center today.
 
 
*To provide feedback about dental care, email Campus Smiles directly at ashedentist@campus-smiles.com. To remain anonymous, fill out this form and we will forward it the Campus Smiles team.*

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* 1. Where were you seen?

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* 2. Using any number from 0 to 10, where 0 is the worst possible and 10 is the best possible, what number would you use to rate your experience at The Ashe Center today?

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* 3. Please use this space to provide any specific feedback or suggestions about your visit today. (In order to protect your PRIVACY, please do NOT include any personal health/medical information as this is NOT an encrypted site)

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* 4. This survey is anonymous. If you would like to be contacted, please provide your email address:

If you would like to contact your student representatives about your experience, please email the Student Health Advisory Committee at shac@ashe.ucla.edu.  NOTICE: In order to protect your PRIVACY, please do NOT include any personal health information in the content of your message. This is NOT an encrypted (i.e. secure) mode of communication and confidentiality cannot be absolutely guaranteed.

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