UHCS Feedback Form "How Are We Doing"

We value your opinion; please help us understand what we do well and what we could do better.

Is there a particular clinic area related to your comments?
Health Services Appointment Process Visit w/Health Provider Reception/Checkout Med. Room Laboratory Efill Triage Nurse/Phone Call	Counseling Services Appointment Process Visit w/Counseling Provider Reception/Checkout Psychiatry Massage Wellness/Outreach UHCS Website
Other:

How would you rate your overall experience.
Excellent Good Fair Unsatisfactory
Please write your comments or suggestions in the box below:

How we can contact you.
As with any UHCS communication, we will keep your comments confidential. This form has no way of identifying you, so you can consider this feedback anonymous. However, if you would prefer, you can include your name, phone or email - especially if you would like a personal response.
Name:
Email:
Phone #:
Please contact me about my comment.
You can also use a printed form available at the Ambrose Health Center, and drop it in one of our comment boxes located throughout the building, give it any UHCS staff, or return it free in Campus Mail. Calling 472-1300 to speak with an administrator is another way to give us your valuable feedback. THANKS FOR YOUR TIME AND COMMENTS!