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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


McLane Student Life Center
2nd Floor
209 Speight Avenue
Waco, TX 76706
Phone: 254.710.1010
Fax: 254.710.2499