Student Satisfaction Survey
Appointment Date
Area Used: Appointment Walk-in Women's Health Clinic
Would you refer the provider you saw to others? Yes No
Provider seen (Please select one name)
Gino Bianchi, MD Graciela Desemone, MD Chris Carlin, PA Margarita Farley, MD Richard Felch, DO Sara Friedman, PA Deborah Hirt, NP Rebecca Kobos, MD Christine McGovern, PA Peter Vellis, DO Doris Walker, NP Not Sure
Please note that the answers to the following 12 questions are set at "Not Applicable" only as a default. Please click on the most appropriate answer for each question.
Please check the appropriate box
Very Satisfied
Satisfied
Unsatisfied
Very Unsatisfied
Not Applicable
1. Friendliness and courtesy of clerical staff
2. Knowledge ability of clerical staff
3. Friendliness and courtesy of clinical staff
4. Thoroughness and explanations provided by clinical staff
5. Ease of scheduling an appointment
6. Waiting time to see provider based on scheduled appointment time
7. Overall quality of care you received
8. Telephone interactions (if applicable)
9. Pharmacy services
10. Laboratory services
11. Building
a.Cleanliness
b. Overall Appearance
c. Temperature
d. Accessibility
Comments/ Suggestions:
Student Status: Freshman Sophomore Junior Senior Graduate Other
Name: (optional) Telephone: (optional) Your comments are important to us. Please leave your name and telephone number so that we may work together to make your visits or telephone interactions more satisfying. Thank you.
For questions regarding the Health Center or the required Health forms, you can email us at: askUHC Please note: No medical advice will be given.
