Davison Health Center - Patient Satisfaction Survey
In our continued effort to provide responsive, quality health services, we ask that you complete the following questions. We would like to thank you, in advance, for taking the time to provide us with your feedback.
I am a
First Year student
Sophomore
Junior
Senior
Graduate student
Partner of a student
Did you make an appointment or walk in?
Appointment
Walk-In
Time and day of your visit
Illness
Injury
Wellness and Sexual Health
GYN services
Lab Testing
Medication refill
Allergy Injections
Immunizations
Travel Consult
Healthy Eating Program
WesWell
Medical Advice/lab results
Nutritionist
HIV Counselor
Other (type reason here)
Strongly Agree Agree
Neutral
Disagree Strongly disagree
Disagree Strongly Disagree Not applicable
Neutral Disagree Strongly disagree
Strongly Agree Agree Neutral
Yes
No
If no, why not?
4). How do you feel our overall services could be improved?
5). What questions do you have regarding the Health Center? (A response will be given if you provide your email address at the end of the survey)
6) What other services would you like provided at the Health Center?
7). If you are interested in becoming a member of the Student Health Advisory Committee (SHAC), please provide your name and contact information below. Go to www.wesleyan.edu/healthservices/geninfo/shac.html for more information.
8). Additional Information you would like staff to know.
You will be contacted if you had any specific questions requiring a reply if you provide your email address below.
Name (optional)
Phone number (optional)
Email (optional)