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* 1. In what school are you currently employed?

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* 2. What was the reason for nurse visit?

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* 3. Professionalism: Please mark how much you agree or disagree with the following statements.

  Strongly Agree  Agree Neutral Disagree Strongly Disagree
School nurse treats students and staff with kindness and respect.
School nurse responds to requests in a timely manner

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* 4. In your opinion, what impact do you think the school nurse is making in:

  Positive impact Somewhat positive impact No impact Somewhat negative impact Negative impact Don't know
The overall well-being of students at your school
Providing support in working with students with chronic medical conditions
Providing support for students with acute illness or emergencies
Improving attendance and academic performance at your school (i.e. returning to class after medical issue)

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* 5. How comfortable do you feel contacting the school nurse with concerns about your students?

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* 6. Please share comments or suggestions on how we could improve our services.

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