Exit this survey Roger Pen Study Question Title * 1. Which of the following best describes your hearing loss? Mild Moderate Severe Profound Deaf How long have you have you had hearing loss? Question Title * 2. Which of the following best describes what kind of hearing devices you use? Hearing Aid in One Ear Hearing Aid in Both Ears Implant in One Ear Implant in Both Ears A Hearing Aid and Implant How long has it been since you got your first device? Question Title * 3. Do you use any of the following products to support or complement your hearing devices when engaged in an in-person conversation with others? Check all that apply. Personal amplifier (e.g. PockeTalker, Comfort Duette, etc.) A microphone plugged into hearing aid(s) or implant(s) Smartphone with app, microphone, neckloop or patch cord Smartphone with app, microphone and earphones (hearing aids removed) FM system (e.g. Comtek, Contego or other brand) or digitally modulated wireless system (e.g. Comfort audio, etc.) Other (please specify) Question Title * 4. Do you use any of the following products to support or complement your hearing devices when watching television or listening to your stereo system? Check all that apply. TV Listening System(e.g. TV Ears, Sennheiser, William Sound, Serene Innovations) Personal amplifier (e.g. PockeTalker, Comfort Duette, etc.) Room loop with my hearing aid(s)/implant(s) set to telecoil. Bluetooth transmitter and hearing aid/implant streamer. FM system (e.g. Comtek, Contego or other brand) or digitally modulated wireless system (e.g. Comfort audio, etc.) Other (please specify) Question Title * 5. How would you describe you overall level of satisfaction with the hearing devices you wear in understanding voices in the following situations? Extremely Satisfied Somewhat Satisfied Somewhat Dissatisfied Extremely Dissatisfied When standing 10 feet or more from the person speaking When standing 10 feet or more from the person speaking Extremely Satisfied When standing 10 feet or more from the person speaking Somewhat Satisfied When standing 10 feet or more from the person speaking Somewhat Dissatisfied When standing 10 feet or more from the person speaking Extremely Dissatisfied In noisy situations, such as crowded restaurants or social gatherings In noisy situations, such as crowded restaurants or social gatherings Extremely Satisfied In noisy situations, such as crowded restaurants or social gatherings Somewhat Satisfied In noisy situations, such as crowded restaurants or social gatherings Somewhat Dissatisfied In noisy situations, such as crowded restaurants or social gatherings Extremely Dissatisfied While at home watching television or listening to the stereo While at home watching television or listening to the stereo Extremely Satisfied While at home watching television or listening to the stereo Somewhat Satisfied While at home watching television or listening to the stereo Somewhat Dissatisfied While at home watching television or listening to the stereo Extremely Dissatisfied Question Title * 6. Check off whether you agree or disagree with the following statements about why you decided to try the Roger Pen when a free trial was offered at your chapter? Agree Disagree I had not heard about it before this offer and it sounded like it might improve my hearing I had not heard about it before this offer and it sounded like it might improve my hearing Agree I had not heard about it before this offer and it sounded like it might improve my hearing Disagree I had heard good things about it before this offer I had heard good things about it before this offer Agree I had heard good things about it before this offer Disagree I need to improve my understanding of voices which are any distance from me I need to improve my understanding of voices which are any distance from me Agree I need to improve my understanding of voices which are any distance from me Disagree I need to improve my understanding of voices in noisy situations I need to improve my understanding of voices in noisy situations Agree I need to improve my understanding of voices in noisy situations Disagree I wanted to see if it would improve my understanding of voices on my cell phone I wanted to see if it would improve my understanding of voices on my cell phone Agree I wanted to see if it would improve my understanding of voices on my cell phone Disagree I wanted to see if it would improve my understanding of the dialogue on television I wanted to see if it would improve my understanding of the dialogue on television Agree I wanted to see if it would improve my understanding of the dialogue on television Disagree Other (please specify) Question Title * 7. How would you rate the following? Strongly Agree Agree Somewhat Disagree Somewhat Strongly Disagee The chapter leaders did a good job of explaining all the uses of a Roger Pen The chapter leaders did a good job of explaining all the uses of a Roger Pen Strongly Agree The chapter leaders did a good job of explaining all the uses of a Roger Pen Agree Somewhat The chapter leaders did a good job of explaining all the uses of a Roger Pen Disagree Somewhat The chapter leaders did a good job of explaining all the uses of a Roger Pen Strongly Disagee The chapter did a good job of explaining how to use the Roger Pen The chapter did a good job of explaining how to use the Roger Pen Strongly Agree The chapter did a good job of explaining how to use the Roger Pen Agree Somewhat The chapter did a good job of explaining how to use the Roger Pen Disagree Somewhat The chapter did a good job of explaining how to use the Roger Pen Strongly Disagee The instructions for the Roger Pen did a good job of explaining all its uses The instructions for the Roger Pen did a good job of explaining all its uses Strongly Agree The instructions for the Roger Pen did a good job of explaining all its uses Agree Somewhat The instructions for the Roger Pen did a good job of explaining all its uses Disagree Somewhat The instructions for the Roger Pen did a good job of explaining all its uses Strongly Disagee The instructions for the Roger Pen did a good job of explaining how to use it The instructions for the Roger Pen did a good job of explaining how to use it Strongly Agree The instructions for the Roger Pen did a good job of explaining how to use it Agree Somewhat The instructions for the Roger Pen did a good job of explaining how to use it Disagree Somewhat The instructions for the Roger Pen did a good job of explaining how to use it Strongly Disagee I found the Roger Pen easy to use for the applications I was interested in I found the Roger Pen easy to use for the applications I was interested in Strongly Agree I found the Roger Pen easy to use for the applications I was interested in Agree Somewhat I found the Roger Pen easy to use for the applications I was interested in Disagree Somewhat I found the Roger Pen easy to use for the applications I was interested in Strongly Disagee If you disagreed, please explain. Question Title * 8. How would rate the difference in your understanding of voices with the Roger Pen versus without the Roger Pen in the following situations or uses? If you did not try the use, please note as such. Did Not Try Roger Pen significantly better Roger Pen somewhat better Roger Pen about the same Roger Pen somewhat worse Understanding voices at a distance Understanding voices at a distance Did Not Try Understanding voices at a distance Roger Pen significantly better Understanding voices at a distance Roger Pen somewhat better Understanding voices at a distance Roger Pen about the same Understanding voices at a distance Roger Pen somewhat worse Understanding voices in noisy situations Understanding voices in noisy situations Did Not Try Understanding voices in noisy situations Roger Pen significantly better Understanding voices in noisy situations Roger Pen somewhat better Understanding voices in noisy situations Roger Pen about the same Understanding voices in noisy situations Roger Pen somewhat worse Understanding voices on my mobile phone Understanding voices on my mobile phone Did Not Try Understanding voices on my mobile phone Roger Pen significantly better Understanding voices on my mobile phone Roger Pen somewhat better Understanding voices on my mobile phone Roger Pen about the same Understanding voices on my mobile phone Roger Pen somewhat worse Understanding voices on television Understanding voices on television Did Not Try Understanding voices on television Roger Pen significantly better Understanding voices on television Roger Pen somewhat better Understanding voices on television Roger Pen about the same Understanding voices on television Roger Pen somewhat worse If anything was rated poor or fair, please explain: Question Title * 9. What did you most like about the Roger Pen? It might a feature, use, a feeling or anything. Question Title * 10. What if anything did you dislike about the Roger Pen? Question Title * 11. What was your most memorable moment using the Roger Pen? Describe why it was memorable. Question Title * 12. Which one of the following best describes how the Roger Pen met your expectations or needs? Meets all of my expectations Meets the majority of my expectations Only meets a few of my expectations Does not meet any of my expectations If any of your important expectations or needs were not being fully met, please describe why not. Question Title * 13. How long did you use the Roger Pen? A few minutes at the chapter meeting Less than a week 1 to 2 weeks 2 to 3 weeks 4 weeks or more Question Title * 14. How often did you use the Roger Pen? Just tried it at chapter meeting Once or less a week Several times a week Daily Several times a day Question Title * 15. Please indicate your level of agreement to each statement on a 10 point scale where 1 equals strongly disagree and 10 equals strongly agree. 1 2 3 4 5 6 7 8 9 10 I would recommend the Roger Pen to anyone with a significant hearing loss I would recommend the Roger Pen to anyone with a significant hearing loss 1 I would recommend the Roger Pen to anyone with a significant hearing loss 2 I would recommend the Roger Pen to anyone with a significant hearing loss 3 I would recommend the Roger Pen to anyone with a significant hearing loss 4 I would recommend the Roger Pen to anyone with a significant hearing loss 5 I would recommend the Roger Pen to anyone with a significant hearing loss 6 I would recommend the Roger Pen to anyone with a significant hearing loss 7 I would recommend the Roger Pen to anyone with a significant hearing loss 8 I would recommend the Roger Pen to anyone with a significant hearing loss 9 I would recommend the Roger Pen to anyone with a significant hearing loss 10 I am interested in purchasing a Roger Pen for my own use. I am interested in purchasing a Roger Pen for my own use. 1 I am interested in purchasing a Roger Pen for my own use. 2 I am interested in purchasing a Roger Pen for my own use. 3 I am interested in purchasing a Roger Pen for my own use. 4 I am interested in purchasing a Roger Pen for my own use. 5 I am interested in purchasing a Roger Pen for my own use. 6 I am interested in purchasing a Roger Pen for my own use. 7 I am interested in purchasing a Roger Pen for my own use. 8 I am interested in purchasing a Roger Pen for my own use. 9 I am interested in purchasing a Roger Pen for my own use. 10 Why did you answer that way ? Question Title * 16. How would answer a friend who asked you if you would recommend the Roger Pen, and why you would either recommended it or not? Question Title * 17. Name the HLAA Chapter which you belong to or which introduced you to the Roger Pen. Question Title * 18. The Roger Pen team may have a follow-up a question based on your responses that could help them improve their next generation of products. If they can contact you, please note your name and contact information below. If only wish to be contacted by either email or phone, only fill in your preferred contact vehicle.THANK YOU FOR YOUR FEEDBACK. Name Phone Email Done