Integrated verification campaign questionnaire for draw – win free copy of Gus Mueller book(Applicable for residents of US and Canada only.) Question Title * 1. Enter code to join the draw for a copy of 'Speech Mapping and Probe Microphone Measurements' by Gus Mueller, Todd A. Ricketts, and Ruth Bentler. (Tip: check lower left corner of banner, print ad or eBlast.) OK Question Title * 2. Contact information Name * Company * Address * Address 2 City/Town * State/Province * ZIP/Postal Code * Country * Email Address * Phone Number * OK Question Title * 3. What is your professional role? Audiologist Hearing instrument specialist Other (please specify) OK Question Title * 4. What best describes the type of facility you work in? (choose one) Private practice Audiology clinic Private practice ENT clinic Private practice hearing instrument specialist Audiology and/or ENT clinic in a hospital and/or university VA hospital or other government facility Retail hearing instrument dispensing chain Other (please specify) OK Question Title * 5. How would you best describe the type of equipment in your clinic (choose one) Hearing assessment Hearing aid verification Verification Tinnitus evaluation/treatment Pediatric services All of the above Other (please specify) OK Question Title * 6. Indicate the age of your equipment and any products you anticipate adding or replacing in the next twelve (12-24) months (select all that apply) Age of equipment is 2-years or less Age of equipment is 3-5 years Age of equipment is 5-years or more Will add/replace in 2018 Will add/replace in 2019 N/A Video otoscope Video otoscope Age of equipment is 2-years or less Video otoscope Age of equipment is 3-5 years Video otoscope Age of equipment is 5-years or more Video otoscope Will add/replace in 2018 Video otoscope Will add/replace in 2019 Video otoscope N/A Clinical/diagnostic audiometer Clinical/diagnostic audiometer Age of equipment is 2-years or less Clinical/diagnostic audiometer Age of equipment is 3-5 years Clinical/diagnostic audiometer Age of equipment is 5-years or more Clinical/diagnostic audiometer Will add/replace in 2018 Clinical/diagnostic audiometer Will add/replace in 2019 Clinical/diagnostic audiometer N/A Screening audiometer Screening audiometer Age of equipment is 2-years or less Screening audiometer Age of equipment is 3-5 years Screening audiometer Age of equipment is 5-years or more Screening audiometer Will add/replace in 2018 Screening audiometer Will add/replace in 2019 Screening audiometer N/A Clinical/diagnostic tympanometer Clinical/diagnostic tympanometer Age of equipment is 2-years or less Clinical/diagnostic tympanometer Age of equipment is 3-5 years Clinical/diagnostic tympanometer Age of equipment is 5-years or more Clinical/diagnostic tympanometer Will add/replace in 2018 Clinical/diagnostic tympanometer Will add/replace in 2019 Clinical/diagnostic tympanometer N/A Screening tympanometer Screening tympanometer Age of equipment is 2-years or less Screening tympanometer Age of equipment is 3-5 years Screening tympanometer Age of equipment is 5-years or more Screening tympanometer Will add/replace in 2018 Screening tympanometer Will add/replace in 2019 Screening tympanometer N/A Probe microphone measurement (PMM) device Probe microphone measurement (PMM) device Age of equipment is 2-years or less Probe microphone measurement (PMM) device Age of equipment is 3-5 years Probe microphone measurement (PMM) device Age of equipment is 5-years or more Probe microphone measurement (PMM) device Will add/replace in 2018 Probe microphone measurement (PMM) device Will add/replace in 2019 Probe microphone measurement (PMM) device N/A Hearing instrument testing (HIT) box Hearing instrument testing (HIT) box Age of equipment is 2-years or less Hearing instrument testing (HIT) box Age of equipment is 3-5 years Hearing instrument testing (HIT) box Age of equipment is 5-years or more Hearing instrument testing (HIT) box Will add/replace in 2018 Hearing instrument testing (HIT) box Will add/replace in 2019 Hearing instrument testing (HIT) box N/A OK Question Title * 7. In how many cases do you use verification? (%) under 10% 11 - 20% 21 - 30% above 30% % of first visits % of first visits under 10% % of first visits 11 - 20% % of first visits 21 - 30% % of first visits above 30% % of follow-up visits % of follow-up visits under 10% % of follow-up visits 11 - 20% % of follow-up visits 21 - 30% % of follow-up visits above 30% % of troubleshooting cases % of troubleshooting cases under 10% % of troubleshooting cases 11 - 20% % of troubleshooting cases 21 - 30% % of troubleshooting cases above 30% OK Question Title * 8. Which of the following topics would you like to learn more about? The benefits of hearing aid verification for clients/patients The benefits of hearing aid verification for clinicians Return on investment (ROI) in relation to buying verification equipment How to get started with verification The role of verification in the HI sales process Workflows that support best practice Integrated verification fitting to prescriptive targets Demonstrating HI features OK DONE
