Hearing Services Survey

"*" indicates required fields

At Audika, your hearing health is extremely important to us. Which is why, it would greatly assist us if you complete our Hearing Services Survey, as part of your appointment today.

Completing this survey will help us to ensure that you receive nothing but the highest standards of service on every visit to Audika.

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

Your details

DD slash MM slash YYYY
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 Client ID will start with a C followed by a string of numbers.

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

3. When your clinician recommended your new hearing device/s what were the most important product benefit for you? Please tick the 3 most important statements.

Looking ahead

4. How likely would you be to recommend us to your friends or family (score 0-10) with 0 not at all likely and 10 as extremely likely.

Any further comments

*For full terms and condition click here.

By clicking submit, you agree to Audika’s Privacy Policy