Audiology Client Survey

Please fill out for the person receiving services (i.e. self, child, parent)
1.I received...(Required.)
2.Appointment started promptly(Required.)
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
N/A
3.Center facilities were acceptable(Required.)
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
N/A
4.Professionalism of the receptionist was appropriate(Required.)
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
N/A
5.Professionalism of the clinician was appropriate(Required.)
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
N/A
6.Fees for service were affordable(Required.)
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
N/A
7.I experienced quality service while being tested(Required.)
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
N/A
8.Results were explained in a way I could understand(Required.)
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
N/A
9.I would recommend the Center to others(Required.)
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
N/A
Please answer the following questions if you were fit with a hearing aid or cochlear implant:
10.My device was ready when promised(Required.)
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
N/A
Overall Experience:
11.Why did you choose the Center?(Required.)
12.The best part about the services I received was...(Required.)
13.How can we change our services to benefit you more?(Required.)
14.Age Range(Required.)
15.Gender:(Required.)
Thank you for your feedback! We do not release your personal data to anyone. 
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