Wellness Education Department Evaluation

Gender:

Male

Female

Staff member seen today:

Granger

Hupperich

Lemoine

McPhatter

Richard

Saichuk

Other Specify:

Please rate the services provided to you:

Office Staff

Courtesy
Poor 1 2 3 4 5 Excellent

Efficiency
Poor 1 2 3 4 5 Excellent

Professional Staff

Courtesy
Poor 1 2 3 4 5 Excellent

Compassion and interest in you as a person
Poor 1 2 3 4 5 Excellent

Answering questions
Poor 1 2 3 4 5 Excellent

Thoroughness in discussing your concerns and developing a plan to deal with them
Poor 1 2 3 4 5 Excellent

As a whole, how are you pleased with the Wellness Education Department?

Very Displeased

Moderately Displeased

Moderately Pleased

Very Pleased

Primary reasons you use the Wellness Education Department (Check all applicable):

Convenience

Confidence in Wellness Staff

Emergency

Previous visits satisfactory

Prepaid service

Suggested by friends

Relatively Inexpensive

Other Please Specify:

What is your greatest concern regarding your personal health?

How did you find out about the Wellness Education Department?

What additional services would you like to see offered by the Wellness Education Department?

Suggestions / Comments?

You may remain anonymous; however if you desire a personal response or if you have a specific complaint against a staff member, the following information is necessary.

First Name:

Last Name:

Address:

Telephone:

Email:

If you have any further questions or comments, please direct them to:

Julie Hupperich, MS, LDN, RD
Assistant Director
LSU Student Health Center
Suite 2, Phone: 225-578-5718

THANK YOU FOR YOUR RESPONSE.