Hearing Services Survey

  • Your hearing health is extremely important. Which is why an essential part of your appointment today is the completion of this survey.

    We need you to do this to ensure that you receive nothing but the highest standards of service on every visit to HearingLife.

    To thank you for your time, you’ll automatically be entered into our monthly prize draw to win a $50 Gift Card.*
  • Your details

  • This can be found on the postcard you received from the clinic, if not please contact your local clinic.
  • This can be found on the postcard you received from the clinic, if not please contact your local clinic.
  • Your experience with us

  • 1. Based on your experience we would like to understand how you rate our service. How do you feel about the following statements?
  • Strongly disagreeDisagreeNeutralAgreeStrongly agree
  • Strongly disagreeDisagreeNeutralAgreeStrongly agree
  • Strongly disagreeDisagreeNeutralAgreeStrongly agree
  • Strongly disagreeDisagreeNeutralAgreeStrongly agree
  • Your experience in the clinic

  • 2. From your experience today we would like to understand how you rate your clinician. How do you feel about the following statements?
  • Strongly disagreeDisagreeNeutralAgreeStrongly agree
  • Strongly disagreeDisagreeNeutralAgreeStrongly agree
  • Strongly disagreeDisagreeNeutralAgreeStrongly agree
  • Strongly disagreeDisagreeNeutralAgreeStrongly agree
  • Strongly disagreeDisagreeNeutralAgreeStrongly agree
  • Strongly disagreeDisagreeNeutralAgreeStrongly agree
  • Your hearing device/s

  • Looking ahead