The Catholic University of America

Health Services Survey

To better serve you, Catholic University Student Health Services would like your feedback on the services you received.  We appreciate all your comments or suggestions.

If you have NOT used any of the Student Health Service, please choose from the following:

Never Sick.
Did not know the facility was available.
Thought I had to have insurance to use the facility.
Didn't know the physician visit was free.
Use other local clinic.

On my last visit I was here for:

I have never visited
Immunizations
Medical Services
Lab Only
Pharmacy Only

I became aware of these services from:

Class:

Gender:

Male
Female

Resident Status:

On Campus
Off Campus

Age:

Number of credits you are taking this semester

Number of hours of employment each week

Appointment conducive to personal comfort, privacy, allowing you to ask questions and give information:

Very Satisfied
Satisfied
Dissatisfied
NA

Seen within 15 min. of scheduled appt. time:

Very Satisfied
Satisfied
Dissatisfied
NA

Explanation of health condition:

Very Satisfied
Satisfied
Dissatisfied
NA

Availability of pamphlets and information

Very Satisfied
Satisfied
Dissatisfied
NA

Adequate time spent with care provider.

Very Satisfied
Satisfied
Dissatisfied
NA

Opportunity to make appropriate follow-up appointment.

Very Satisfied
Satisfied
Dissatisfied
NA

Cleanliness and appeal of building and office.

Very Satisfied
Satisfied
Dissatisfied
NA

Skill, knowledge and caring exhibited during visit.

Very Satisfied
Satisfied
Dissatisfied
NA

Were your health care needs met?

Yes
No

Would you return for further care if needed?

Yes
No

Would you recommend our services to fellow students?

Yes
No

How important is it to you to have student health services located on campus?

Very Important
Somewhat Important
Not Important

Have you missed classes or exams due to illness?

Yes
No

Have you dropped a class due to illness?

Yes
No

Was your academic progress supported in any way by the services of the Student Health Center?

Yes
No

If "Yes", please describe:

Comments?

Concerns?

Would you like an opportunity to discuss your comments or concerns?

Yes
No

Optional:

Name

Home Phone

E-mail