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Comment Card

 
 
 

Have you used the Health Service recently and have a comment on the quality of health care you received? Consider filing in the Web Comment Card below. This Web form is primarily for the use of Northwestern University students and other members of the Northwestern Community who have specific comments on their utilization of Northwestern University Health Service. Responses will be limited to those individuals directly affiliated with Northwestern. Users are warned not to use this form for submitting questions or problems relating to a need for urgent medical care. Call the Health Service at 847 491-8100 if you have any medical condition requiring urgent care.

Date of visit:

Time of arrival at the Health Service: a.m. p.m.

Time seen: a.m. p.m.

Type of visit:

Name (optional):

Telephone number:

E-Mail Address:

Whom did you see?

Were you satisfied with the performance of the Health Service? yes no

Please note your comments, suggestions and/or questions.

Would you like a response (if yes, please ensure your e-mail address is correctly filled in above)? yes no

When you are done completing your information, please click on the "submit" button

Thank you for your time and effort in helping us improve the quality of care at Northwestern University Health Service.