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1. What prompted you to consider attending the hearing service? *
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2. What was the level of impact upon your quality of life before you accessed the hearing service? *
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3. How far did you travel to access a hearing aid service? *
4. Could you have chosen a service closer to home?
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5. What was more important to you? *
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6. Do you feel your needs were adequately supported at assessment, fitting or the provision of follow up care? *
7. If you have dementia, were your needs supported at assessment, fitting or the provision of follow up care?
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8. Do you feel that you were supported with informed choice around whether you had 1 or 2 aids fitted? *
9. If you have an NHS provided hearing aid, how satisfied are you with the aid?
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10. Has your quality of life improved since having your hearing aid(s) fitted? *
11. Are you still wearing your hearing aid(s) and if so how often?
12. Do you feel you have received enough information and support to look after and maintain your hearing aid(s) for the long term, either with follow up appointments or help with the replacement of batteries or re-tubing?
13. If you need additional support do you know where to go?
14. Are you registered with a G.P. in
15. Are you aged between:
16. If you completed this form are you the:
17. Please include any additional comment relating to the Audiology service