Sincock & Till Audiology Client Feedback Form

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How would you rate your interactions with your audiologist?

Very Good

Good

Neutral

Poor

Very Poor

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How would you rate your interactions with our front line care team?

Very Good

Good

Neutral

Poor

Very Poor

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How likely is it that you would recommend our clinic to a friend or family member? *

Not likely at all

Extremely likely

If you wear hearing aids, how often do your current hearing aids improve your quality of life?

Always

Most of the time

Sometimes

Very little

Never

Not applicable

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If you wear hearing aids, how many hours a day do you wear them?

0-1

2-4

5-7

Not applicable

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If you wear hearing aids, how long have you been wearing them?

0-1 year

2-4 years

5-6 years

7-8 years

9+ years

Not applicable

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If you wear hearing aids, when it’s time to repurchase hearing aids, how likely are you to return to your current provider?

Extremely likely

Likely

Neutral

Unlikely

Extremely unlikely

Not applicable

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If you wear hearing aids, what factors influenced your most recent choice in buying hearing aids? (select all that apply)

Range of products

Price

Reputation of clinic

Advertising

Recommendation

Not applicable

Other:

What is something we could improve based on your experiences with our clinic?

Please provide any comments on your answer choices or on your experiences with our clinic.

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