Audiology outpatient survey

Please let us know about your experience here today

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* 1. Where did you attend your appointment?

West Middlesex University Hospital

Feltham Centre for Health

Whitton Corner Health & Social Care Centre

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* 2. Were you happy with information provided before (eg. appointment letter) and during (eg. Explanations by staff / hearing aid guidance book) your examination?

	Very clear and understandable	Somewhat clear and understandable	Not clear or understandable at all
Before	Before Very clear and understandable	Before Somewhat clear and understandable	Before Not clear or understandable at all
During	During Very clear and understandable	During Somewhat clear and understandable	During Not clear or understandable at all

If you answered 'Not clear or understandable at all', please tell us why?

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* 3. How would you rate the reception and waiting area at your audiology appointment?

Very clean and tidy

Somewhat clean and tidy

Not clean and tidy

Any further comments?

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* 4. How long did you have to wait after your booked appointment time?

I was seen earlier than my booked time

I was seen on time

I was seen within 15 minutes of my booked time

I was seen within 15 to 30 minutes of my booked time

If you had to wait more than 30 minutes after your booked time, how long did you wait?

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* 5. When you were called in, did you feel respected and spoken to politely by the Audiology staff member?

	Yes	No
Respected?	Respected? Yes	Respected? No
Politely spoken to?	Politely spoken to? Yes	Politely spoken to? No

If you answered no, please tell us why?

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* 6. Did you feel that the Audiology staff member clearly explained the purpose of your appointment to you in a way that was easily understood?

Easily understood

Somewhat understood

Not understood at all

Any further comments?

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* 7. If your appointment today was about a problem with your hearing aid, did we offer you an appointment within two working days and did we resolve the problem?

	Yes	No	Not applicable
Appointment offered?	Appointment offered? Yes	Appointment offered? No	Appointment offered? Not applicable
Problem resolved?	Problem resolved? Yes	Problem resolved? No	Problem resolved? Not applicable

If you answered no, please tell us why?

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* 8. Thinking about the service we provide, overall, how was your experience of our service today?

Very good

Good

Neither good nor poor

Poor

Very poor

Don't know

Audiology outpatient survey

Question Title

* 1. Where did you attend your appointment?

Question Title

* 2. Were you happy with information provided before (eg. appointment letter) and during (eg. Explanations by staff / hearing aid guidance book) your examination?

Question Title

* 3. How would you rate the reception and waiting area at your audiology appointment?

Question Title

* 4. How long did you have to wait after your booked appointment time?

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* 5. When you were called in, did you feel respected and spoken to politely by the Audiology staff member?

Question Title

* 6. Did you feel that the Audiology staff member clearly explained the purpose of your appointment to you in a way that was easily understood?

Question Title

* 7. If your appointment today was about a problem with your hearing aid, did we offer you an appointment within two working days and did we resolve the problem?

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* 8. Thinking about the service we provide, overall, how was your experience of our service today?

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* 9. Can you think of any other suggestions we can do to improve the service?