Audiology - Patient Satisfaction Form

Help us to improve our services


Please complete every section by ticking the appropriate box next to each question. If a question doesn’t apply to you, please ignore it and move onto the next question.

Your response will be analysed and the findings used to inform us on how we can improve our services to you.

Personal information will not be released to any other party

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* 1. Are you male or female?

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* 2. In what year were you born? (enter 4-digit birth year; for example, 1976)

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* 3. What was the main factor that made you decide to come to Action for Deafness?

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* 4. How did you hear about Action for Deafness?

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* 5. What type of audiology appointment did you have?

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* 6. Are you aware of other Action for Deafness Hearing Test centres?
(Haywards Heath, Burgess Hill, Worthing, Steyning, Crawley, East Grinstead, Lewes, Henfield, Horsham, Heathfield, Bognor Regis and Shoreham)

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* 7. Were you given a suitable appointment date/time that was acceptable to you?

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* 8. How useful did you find the printed information given to you before your appointment?

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* 9. How organised was the appointment process?

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* 10. Overall how would you rate the cleanliness of the consulting room?

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* 11. How would you rate the friendliness and helpfulness of staff during your visit?

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* 12. How would you rate the overall quality of service provided to you during your visit?

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* 13. Do you know if other users are satisfied with the service Action for Deafness provides?

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* 14. Please tick below if the conditions met your requirements of the service.

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* 15. Which audiologist did you see today?

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* 16. Did you have confidence and trust in the audiologists treating you?

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* 17. Did you feel involved in decisions about your care and treatment?

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* 18. When being examined or treated, was your privacy and dignity respected?

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* 19. Were the answers given clearly to your questions about your hearing aids?

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* 20. After receiving your hearing aid(s), was the information given clear, regarding usage and maintenance?

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* 21. Please tick any AFD service the audiologist advised you about.

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* 22. Were you offered Communication Tactics Training?

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* 23. Did you attend a Communication Tactics Training session?

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* 24. Did the audiologist encourage you to visit the Resource Centre?

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* 25. Before you left the appointment, were you provided with details of what to do if you had any concerns regarding your hearing aid?

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* 26. Were the staff at Action for Deafness well informed?

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* 27. How would you rate the overall care you received at this appointment ?

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* 28. Would you recommend AFD to your family and friends?

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* 29. Are you aware that Action for Deafness is UKAS accredited against IQIPS standards?

The IQIPS programme has the aim of improving service quality, care and safety for patients undergoing physiological diagnostics and treatment. IQIPS has a self-assessment and external peer assessment against a set of 26 standards to assess the level of performance compared to the standards and to implement ways to continuously improve.  United Kingdom Accreditation Service (UKAS) has been appointed by the Royal College of Physicians to manage and deliver the IQIPS assessment and accreditation scheme.

 

If you would like to influence the continual improvement of services you can join AFD’s Patient Participation Group. For more information about the group, please contact us.

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* 30. Please add any suggestions that might help us to improve the service we provide to patients or any other comments you wish to add. You may like to mention any staff by name who provided you with especially good service and say what they did that was exceptional.

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* 31. To ensure that AFD provides equal opportunities, please could you tick one box to show which ethnic group you belong?

We value your opinion



At Action for Deafness we aim to provide exemplary services to every patient. To help us measure if we are reaching these standards we would be most grateful if you took a few minutes to complete this survey about your experience of Action for Deafness.

Your opinions and comments are extremely valuable to us and we will use them to identify opportunities for improvement and to highlight areas of success.

All feedback from patients will be treated in the strictest of confidence unless you indicate otherwise.

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