Print out and check, circle or fill-in your answers where appropriate.
|How often have you used the health center this school year?|
|First time||2-5 times||6-10 times||More than 10 times|
|What are you being seen for today? (OPTIONAL)|
Who are you seeing today?(Check one)
Did you have an appointment or did you walk-in for care today?
How likely are you to follow the advice of health center staff?