* 1. Please state the clinic location where you had your appointment:

* 2. Please state your age:

Please rate our services from 1 to 10, by choosing one number for each question.
1 = Poor        10 = Outstanding

* 3. Following your Doctor's referral for hearing tests, how would you rate the waiting time before receiving your first appointment from the Audiology clinic?

* 4. How would you rate the information provided prior to your first appointment?

* 5. Did the Audiologist confirm your ID and take your consent prior to your appointment commencing? If yes, how would you rate this?

* 6. How would you rate the Audiologist's communication throughout your appointment?

* 7. Did the staff treat you with care, respect and courtesy?

* 8. Did you feel that you could discuss things in confidence? If yes, how would you rate this?

* 9. Prior to your hearing test, did the Audiologist provide clear instructions and explain about the test? If yes, how would you rate this?

* 10. Did the staff explain the results of the tests clearly to you? If yes, how would you rate this?

* 11. How would you rate the information provided about your hearing aids (other treatment or therapy) and recommendations?

* 12. Following your appointment, did the Audiologist cover all your questions and concerns? Please rate this.

* 13. How would you rate the printed information provided, following your hearing aid fitting?

* 14. How would you rate your follow up appointment - either at the Audiology clinic or over the telephone?

* 15. How easy has it been to contact SHC Audiology?

* 16. How helpful have you found your hearing aids (other treatment or therapy)?

* 17. If you have any comments, suggestions or complaints about our Audiology Service, please state below:

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