..home..
about us..
Office of the President
Administrative Offices
Campus Facts
News & Events
Employment
Technology
Directions, Maps & Parking
Campus Police & Safety
Cougar Athletics
Contact Us
..admissions..
..academics.
Academic Offerings
Colleges & Programs
Library
Bookstore
University Catalog
Class Schedules, Registration & Fees
Graduation Requirements
Commencement 2009
Centers & Institutes
Diversity, Social Justice & Equity
..students..
Student News & Calendars
Cougar Central
Resources & Services
Library
Bookstore
Campus Life
Commencement 2009
Cougar Athletics
MyCSUSM
WebCT: Online Courses
Webmail
..faculty & staff..
Faculty & Staff News & Calendars
Administration
Faculty Resources
Employee Resources
Library
Bookstore
Commencement 2009
Policies & Procedures
MyCSUSM
WebCT: Online Courses
Webmail
..alumni..
..community..
Office of the President
Directions, Maps & Parking
Community Engagement
Parents & Family
Arts & Culture
Extended Learning
Employment
Media Resources
..giving..
Introduction: Imagine More
Ways to Give
Annual Fund
Invest Online Now
Honor Roll of Donors
Special Events
Student Health and Counseling Services
About SHCS
Contact Us
SHCS Location
SHCS Staff
Accreditation
Patient Feedback
General Information
Medical Services
Counseling
Health Education
Pharmacy
Immunizations
Emergency/ Resources
Family PACT
Health Events
Swine Flu
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.
Loading reCAPTCHA...
You didn't correctly type the text in the security check box.
Send Form
