..home..
about us..
Office of the President
Administrative Offices
Campus Facts
NewsCenter
Employment
Technology
Directions, Maps & Parking
Campus Police & Safety
Cougar Athletics
Contact Us
..admissions..
..academics.
Academic Offerings
Colleges & Programs
Graduate Studies & Research
Library
Bookstore
University Catalog
Class Schedules, Registration & Fees
Graduation Requirements
Diversity, Social Justice & Equity
..students..
Student News & Calendars
First Year Students
Cougar Central
Campus Housing
For Families & Parents
Resources & Services
Library
Bookstore
Campus Life
Cougar Athletics
MyCSUSM
Cougar Courses
Webmail
..faculty & staff..
Faculty & Staff News & Calendars
Administration
Faculty Resources
Employee Resources
Library
Bookstore
Policies & Procedures
MyCSUSM
Cougar Courses and Online Instruction
Webmail
..alumni..
..community..
What is Community Engagement?
Events, Educational Programs & Resources
For Students
For Chambers & Businesses
For K-12 Schools
For Tribal Communities
For the Military Community
Awards & Accolades
Extended Learning
Host Your Event at CSUSM
Visit CSUSM
..giving..
Giving Overview
Make Your Gift Today
Our Stories
Annual Fund
President's Circle
Planned Giving
Honor Roll of Donors
Annual Gala
CSUSM Foundation
Student Health and Counseling Services
Hours of Service & Contact
Message to Parents
About SHCS
SHCS Location
SHCS Staff
Accreditation
Patient Feedback
General Information
Medical Services
Counseling
Health Education
Pharmacy
Immunizations
Emergency/ Resources
Family PACT
Programs & Events
Student Health and Counseling Services
Cal State University San Marcos
PATIENT COMPLIMENT/SUGGESTION/COMPLAINT FORM
Date:
Date: is a required field!
Patient's Name (Optional):
Patient's Name (Optional): is a required field!
Phone Number (Optional):
Phone Number (Optional): is a required field!
Address to Send Response (Optional):
Address to Send Response (Optional): is a required field!
Type of Feedback
Compliment
Suggestion
Complaint
Type of Feedback is a required field!
Location of Compliment/Suggestion/Complaint:
Medical Reception (Check In/ Check Out)
Pharmacy
Physician/ Nurse Practitioner
Nurses
Family PACT
Psychiatry
Counseling Services
Health Education/ HOPE & Wellness Center
Location of Compliment/Suggestion/Complaint: is a required field!
Name of Staff for Whom you have a Compliment/Suggestion/Complaint
Name of Staff for Whom you have a Compliment/Suggestion/Complaint is a required field!
Please describe your compliment/suggestion/complaint at SHCS
Please describe your compliment/suggestion/complaint at SHCS is a required field!
Describe What Would be an Acceptable Outcome for You?
Describe What Would be an Acceptable Outcome for You? is a required field!
Thank you for taking the time to provide us with this valuable feedback information. Please give us your address if you would like a written response from us.
Submit