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Health, Wellness and Counseling Center
Supporting Student Success
Clinical Services - Customer Service Suggestion Form

    Please check one in each of the categories below that best describes you?

Undergraduate Student Graduate Student

Male Female

On-campus Off-campus

    Customer Service

          Please comment on the following factors:

Time waited until seen: 10 Minutes 20 Minutes 30 Minutes >30 Minutes

Staff Competence: Excellent Good Fair Poor

Accomodations: Excellent Good Fair Poor

          Self Check-In: Excellent Good Fair Poor 

          Web Appointment Process: Excellent Good Fair Poor

    Please include the date/time of your visit, and your specific concern or recommended corrective action :

    Tell us how to get in touch with you: (optional)

Name
E-mail
Tel
FAX
Please contact me as soon as possible regarding this matter.

   

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