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Tell Us How We’re Doing

Tell us what you think! 

 

Your opinion matters to us! We want to know how we’re doing and what we can improve. Please take a few minutes to answer the questions on this form. You may print it and return it to the nurse in C2113. If the clinic is closed slide it under the door. Thank you for your help . 

 

Question 

Strongly agree 

Agree 

Disagree 

Strongly disagree 

Not Applicable 

I was treated with respect.

 

 

 

 

 

The nurse was knowledgeable.

 

 

 

 

 

My questions and concerns were addressed in a timely manner.

 

 

 

 

 

The nurse provided useful referrals and resources.

 

 

 

 

 

The nurse taught me new things to do at home for my health.

 

 

 

 

 

The services I needed were provided.

 

 

 

 

 

Why did you go to the clinic?

 

                  

How can we improve our services?

 

 

What are we doing well?

 

 

General comments:

 

 

Tell us about yourself. Complete all that apply.

 

Male – Yes or No

 

Female – Yes or No

 

Age

 

Student – Yes or No

 

Faculty/staff – Yes or No

 

Ethnicity/Race

 

What year student are you?

 

 
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