Online Survey | Built with Qualtrics Experience Management™

Campus Health Feedback Form

Your feedback is important to us and helps improve the care and services we provide. Please be as specific as possible when completing the following form. Your comments will be confidential and will not become part of your health record. Thank you!

Date MM/DD/YYYY

My comment concerns the following:

The Health Center Uptown
Pharmacy
The Health Center Downtown
Counseling and Psychiatric Services (CAPS)
The Well for Health Promotion
Tulane Telehealth -24/7 Virtual Urgent Care
Website
Other/General

Copy and paste the web page URL here:

This is a:

Comment
Complaint
Suggestion

Please share detailed information below (including names, dates, and times if applicable):

Would you like to be contacted by Campus Health Staff?

Yes
No

Please provide this information if you want follow-up to occur.

First Name

Last Name

Splash ID

Email

Phone Number (555) 555-5555

The best time and/or method to contact me is: