Audex - The Leader in Assistive Listening Devices

Your answers help us to develop better technology to assist hearing impaired individuals and to enhance assistive listening devices for anyone who needs clearer communications. Please fill out the following questionnaire as completely as possible. Thank you.


Name:
Address:
City:
State (if in US):
Zip:
Age:
Gender:
Occupation:
E-Mail Address:
Business Phone (with area code):
Home Phone (with area code):


Are you:
If Other:
If you don't have hearing loss:	Skip to Cell Phone Questions
Is your hearing loss:
Do you wear hearing aids?
If you don't wear hearing aids:	Skip to Cochlear Implant Questions
Right Ear:
If Other:
Left Ear:
If Other:
What Make and Model?
How long have you worn hearing aids?
How long have you worn your current hearing aid?
How well do you understand in noise with your aids?
Are you able to understand speech over the telephone with your hearing aids?
Without hearing aids?
Are you aware of cochlear implant technology?
Do you have a cochlear implant?


Do you own a cellular phone?
If you do own a cellular phone:	Skip to Make and Model
If No why not?
Do you plan to get a cellular phone in the next six months?
What make and model do you think you will get?
If you answered the previous question:	Skip to Questions About Minutes
What is the make and model?
If you or your family owns more than one phone please list the make and model of additional phones.
How long have you owned your primary cell phone?
How many different models of cellular phones have you owned in the past?
How long do you normally keep a cellular phone model?
Do you use your phone for business?
If you answered no:	Skip to Questions About Minutes
Do you ever need to use your phone for conference calls while traveling?
Do you have the need to record conversations?
How many minutes per month do you talk?
Generally how do you understand conversation on your phone?
How well do you understand conversation over your cell phone in noisy environments?
Do you ever wish you could make your cellular phone louder?
Do you ever have trouble hearing you cellular phone ring?
Do you ever find it necessary to write down information while on your cellular phone?
Do you use a hands free attachment with your cellular phone?
Do you use a car kit with your cellular phone?
If yes is it boosted for longer range and improved reception?
What do you like most about your current model of phone?
What do you like least?
What features would you like to see on cellular phones?
If you do not wear hearing aids:	Skip to Cochlear Implant Questions
Does your cellular phone create noise in your hearing aid?
If no:	Skip to T-Coil Questions
Does the noise prevent you from effectively using your phone?
Do you have a t-coil on your hearing aid?
If no:	Skip to Cochlear Implant Questions
Can you use your t-coil with your cellular phone?
If no, would you like to be able to use your t-coil with your hearing aid?
Do you own a NOKIA Loopset?
If no:	Skip to Cochlear Implant Questions
Does the t-coil help you communicate over your cellular phone?
What do you like most about the Loopset?
What do you like the least?
What feature would you like to see added to the Loopset?
If you do not have a cochlear implant:	Skip to Additional Comments
What make and model cochlear implant do you wear?
Does your cellular phone create noise in your implant?
Can you hear well on your cell phone through your implant?
What change to the cell phone would make it easier to hear with your implant?
Additional comments:
Would you like to know about Audex® products that help you communicate over telephones?
Would you like Audex® to keep you informed about new products that will become available in the future?
Would you like to receive the Audex® Newsletter to begin this fall?

If you answered yes to the last three questions, please make sure you have filled out the name, address and email address questions on the questionnaire.


I understand that this information will not be used in any way by parties other than those who administer it (Audex®). Other standard warnings from non-secured Internet message transmissions apply as per any E-mail systems. Again, the information offered by the respondents of this program will be held in strictest confidence.
I agree with the conditions: