Patient Satisfaction Survey

Which office did you visit today?
Which audiologist did you see today?

Please rate your satisfaction with the following: (please check one)	Very Satisfied	Satisfied	Neither Satisfied or Dissatisfied	Dissatisfied	Very Dissatisfied	Does Not Apply
1. Efficiency/ease of scheduling
2. General appearance of the office
3. Time it took to get an appointment
4. Professionalism and helpfulness of:
Your Audiologist
The support staff
5. Knowledge of the audiologist/staff
6. Quality of testing equipment
7. Advice on selection/use of hearing aids
8. Quality and variety of hearing aids
9. Cost of your hearing instruments
10. Hearing aid return privilege
11. One year of hearing aid services (included in cost of hearing aid(s))
12. Cost for office visits and other services
13. Overall quality of care
Additional comments are welcomed: