
	Health & Counseling Services Survey

The University Health and Counseling Center requests your feedback to help us better serve our students. This information will be used to assess and implement important health services. Please take a few minutes to complete the following questions. Your time and thoughts are appreciated.

Sex

Male

Female

Class Standing

Freshman	Senior	Staff
Sophomore	Graduate	Faculty
Junior	Not Sure	Community

Please indicate where you received care today

Health (Physician)	Women’s health	Pharmacy
X-ray	Laboratory	Counseling
Nurse visit	HIV counseling/testing	Drug/alcohol intervention program
Other (please indicate)

Quality of Service

	Excellent	Good	Fair	Poor	Unacceptable	Not Applicable
Staff Listened to what I had to say
Answered all pertinent questions
Illness/Injury was explained
Staff was courteous and helpful
Staff provided explanation of medication and how to use it
Felt comfortable enough to tell or ask clinical staff everything that you wanted to know
Staff spoke clearly and used terms that I could understand
Staff able to provide adequate alternatives to care while waiting for NP/physician
Kept informed of delays in waiting time
Counselors clearly explained their role in my treatment
Staff spend adequate time with me
Staff spend adequate time with me
Nurse discussed how to care for myself and how to prevent reoccurrence
Felling satisfied with the health/counseling information provided
Appointment availability met my needs
Provided clear instructions for care and treatment of problem or illness

Would you recommend our services to others on campus?

Yes

Of the different types of services we provide, which do you feel are the most important to serving our students only? Select the services you think important.

Discount Pharmacy	Free Flu Shots	Audiological Services
Gynecological Services	STD Testing	Anonymous HIV Testing
Cholesterol Screening	X-Ray Services	Others

If you have any comments or suggestions regarding this questionnaire or services provided, please make comments below. Your name is not required but if you should have a problem with the services, providing your name and number gives us the opportunity to discuss the problem further and help us to improve our services.