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CH&W Feedback

Feedback

Campus Health & Wellbeing strives to provide the best service possible to our students. We appreciate any feedback you have regarding your experience with our services.

1. Name (Optional)

2. Email (Optional) This question requires a valid email address.

3. Phone Number (Optional)

4. Would you like to be contacted?

5. What area of service in Campus Health & Wellbeing are you providing feedback for? (check all that apply) *This question is required.

Counseling
Health Services (Medical)
Health Education (PULSE)
Wellbeing
Pharmacy
Lab
X-Ray
Reception
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

6. How would you rate your overall service today? *This question is required.

Very Satisfied	Satisfied	Neutral	Dissatisfied	Very Dissatisfied	Not applicable
Very Satisfied	Satisfied	Neutral	Dissatisfied	Very Dissatisfied	Not applicable

7. What feedback would you like to provide us? *This question is required.