Thank you for selecting our practice for you hearing care needs! To ensure that you were happy with your visit, we would truly appreciate if you would take a few moments to complete and return this Patient Satisfaction Survey. Your answers will help us evaluate and improve the quality of our services.

Patient Survey Listed below are key areas of our patient care. Please check the box that most accurately describes your experience:     Excellent Good Fair Poor Your initial phone call to our office?*   Please make a selection. Courtesy & friendliness of hearing care provider?*   Please make a selection. Explanation of Your Test Results and Recommendations?*   Please make a selection. Explanation of Your Hearing Instrument Benefits and How to Use Your Devices?*   Please make a selection. Overall impression of your visit to our office?*   Please make a selection. Do you believe the treatment you received met your expectations?*   Yes No Please make a selection. Would you feel comfortable referring a family member or friend to our practice?*   Yes No Please make a selection. What can we do to make our patient care experience even better?   Minimum number of characters not met.Exceeded maximum number of characters. First Name   Minimum number of characters not met.Exceeded maximum number of characters. Last Name   Minimum number of characters not met.Exceeded maximum number of characters. Phone   Invalid format. example: (555) 555-5555 Which location did you visit?* Castle Rock Minimum number of selections not met.Maximum number of selections exceeded. Parker Fields with and asterisk * are required. Thank you for taking the time to provide us with this information! We appreciate your feedback and your patronage.

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