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Feedback Form

Baylor > Health Center > Feedback Form

Feedback Form

In order to maintain and improve the services we provide, compliments, suggestions, and complaints regarding your health clinic visit are important.

Date of Your Visit:
Time of Your Visit:

Please be as specific as possible giving names and/or characteristics of the person(s) involved. If you were dissatisfied with an aspect of your visit, suggest a possible resolution. Consider the following aspects when commenting on the care you received:

Did our staff give you their full attention during your visit?
Were you given realistic expectations during your care?
Did you receive all of the care you needed?

In case questions arise or a need for clarification, please complete the following information.

All information is strictly confidential and will not become a part of your medical record.

First Name:
Last Name:
Baylor ID#:
Email Address:
Phone:
Would you like to be contacted by the BU Health Services Administration?
	By email
	By Phone