Cochlear Implant Satisfaction Survey
Help us improve by sharing your experience and satisfaction with your cochlear implant.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Age
*
How long have you been using a cochlear implant?
*
Please Select
Less than 1 year
1-3 years
4-6 years
More than 6 years
Which brand of cochlear implant do you use?
*
Please Select
Cochlear
MED-EL
Advanced Bionics
Oticon Medical
Other
Please rate your satisfaction with the following aspects of your cochlear implant.
*
Rows
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Sound quality
1
2
3
4
5
Ease of use
6
7
8
9
10
Comfort of wearing
11
12
13
14
15
Battery life
16
17
18
19
20
Device reliability
21
22
23
24
25
Overall, how would you rate your satisfaction with your cochlear implant?
*
1
2
3
4
5
How often do you use your cochlear implant?
*
All day, every day
Most of the day
Only in specific situations
Rarely
Have you experienced any challenges or difficulties with your cochlear implant? (Select all that apply)
*
Device malfunction
Discomfort or pain
Difficulty hearing in noisy environments
Battery issues
None
Other
How satisfied are you with the support and services provided by your cochlear implant provider?
*
Very Dissatisfied
1
2
3
4
Very Satisfied
5
1 is Very Dissatisfied, 5 is Very Satisfied
Please share any additional comments or suggestions regarding your experience with your cochlear implant.
Submit Survey
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