Washington University EARtrak Hearing Aid/Device Satisfaction Survey

Washington University is interested in your hearing care experience as a consumer. We would like your opinions about the quality of service received from your provider, and the performance of your most recently fitted hearing aid/device(s).

To obtain your opinion, we would like you to complete the EARtrak survey below.

Please be assured that all surveys are confidential and that your personal information remains with us unless YOU choose to have this forwarded to your service provider. All personal information collected by EARtrak is protected under our privacy policy, available on the EARtrak website.

Question Title

* 1. If you have been invited by Washington University to complete an EARtrak survey online, please enter the Patient Number from your invitation. Otherwise, please enter your name.

(Note: You may complete this survey even if you have not had an invitation from Washington University.)

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* 2. Which Washington University clinic did you attend?

Audiology Clinic at CID Building (1002-03)

West County ENT (1002-02)

Center for Advanced Medicine (1002-01)

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* 3. Who fitted your hearing aid/device?

Cathryn Collopy , AuD. (031)

Diane Duddy, AuD (021)

Jennifer Listenberger, AuD. (022)

Alison Brockmeyer, AuD. (012)

Judy Peterein, AuD. (013)

Adam Voss , AudD. (014)

Rachael Mangiore, AuD. (016)

Steven Smith, AuD. (015)

Michael Valente, Ph.D. (011)

Unsure/Don't Remember

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* 4. A few questions about you

Male

Female

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* 5. Do you wear a hearing aid/device

Left ear only

Right ear only

In both ears

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* 6. Age (years)

0-9

10-19

20-29

30-39

40-49

50-59

60-69

70-79

80-89

90+

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* 7. How was your hearing aid/device paid for?

Medicaid

Hospital Replacement

Private/Self Paid

Veterans' Administration

Vocational Rehabilitation

Other (please specify)

Question Title

* 1. If you have been invited by Washington University to complete an EARtrak survey online, please enter the Patient Number from your invitation. Otherwise, please enter your name.(Note: You may complete this survey even if you have not had an invitation from Washington University.)

Question Title

* 2. Which Washington University clinic did you attend?

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* 3. Who fitted your hearing aid/device?

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* 4. A few questions about you

Question Title

* 5. Do you wear a hearing aid/device

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* 6. Age (years)

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* 7. How was your hearing aid/device paid for?

* 1. If you have been invited by Washington University to complete an EARtrak survey online, please enter the Patient Number from your invitation. Otherwise, please enter your name.

(Note: You may complete this survey even if you have not had an invitation from Washington University.)