Cerritos College

Please answer the questions as they relate to your most recent visit:

1)  At Cerritos College, how many times have you visited  Student Health Services?

1
2 - 5
6 - 9
10 - 19
20 - more

2) If you made an appointment for your most recent visit, how satisfied were you with the ease of getting your appointment?

Not satisfied
Somewhat satisfied
Very satisfied

3)  How would you relate the care and services provided by the Student Health Center staff?

Receptionist
Poor  Fair  Good  Very Good  Excellent  Not Applicable

Medical Assistant 
Poor  Fair  Good  Very Good  Excellent  Not Applicable

Registered Nurse 
Poor  Fair  Good  Very Good  Excellent  Not Applicable

Physician / Nurse Practitioner  
Poor  Fair  Good  Very Good  Excellent  Not Applicable

Laboratory
Poor  Fair  Good  Very Good  Excellent  Not Applicable

Pharmacy 
Poor  Fair  Good  Very Good  Excellent  Not Applicable

4)  How satisfied were you with the overall wait time for services after your arrival?

Not satisfied
Somewhat satisfied
Very satisfied

5)  Regarding your contact with the medical provider (Physician or nurse Practitioner), please rate the following:

His or Her explanation of your condition 
Poor  Fair  Good  Very Good  Excellent  Not Applicable

His or Her concern for your condition
Poor  Fair  Good  Very Good  Excellent  Not Applicable

Your understanding of the Medical advice given
Poor  Fair  Good  Very Good  Excellent  Not Applicable

6)  Overall, how satisfied were you with your visit at Student Health Services?

Not satisfied
Somewhat satisfied
Very satisfied

7)  How important is it for you to have health services available for you on campus?

Not satisfied
Somewhat satisfied
Very satisfied

8)  What can Student Health Services do to improve the services you receive?

9)  What is the most important aspect to you in seeking care?

Same day  Service (Walk - in)
Low cost
Expedient Services - Limited Time Waiting
Female / Male Provider
Other
 

10) Would you recommend Student Health Services to other students?

Yes   
No  

11) Do you receive services from other campus programs (check all that apply)?

Child Care
Financial Aid
International Student Program
Disabled Student Program
EOPS
Cal Works

12)  Please write any comments / suggestions you would like us to know.

Age: Sex Medical Insurance Yes No

(Optional Information)

Name:
Ethnicity: 
Phone:
Email:

Would you like to belong to a SHS email list ? Medical Insurance Yes No

Thank you.