AUDIOLOGY FORUM: VIDEO OTOSCOPY
CLIENT SURVEY

[CGI scripts by Scott Manning, Web Programmers, Inc.]

TO: ALL AUDIOLOGY FORUM VIDEO OTOSCOPY VIEWERS

We begin our sixth of logged activity. I have devoted considerable personal time and effort to sharing this clinical information with you. To date, there have been more than 125,000 visits to this site from more than 100 countries. I add and edit data, virtually on a daily basis. After you have browsed the website, please take a one minute excursion to respond to this twelve question, mouse-click data-entry survey. Your answers and comments will assist me in shaping the future direction of my hypertext teaching efforts on VIDEO OTOSCOPY and other HEARING HEALTH-RELATED TOPICS.

Thank you, in advance, for your kind support.

RFS

Please enter your name (OPTIONAL, BUT HELPFUL):

and your e-mail address (OPTIONAL, BUT HELPFUL):

Is this your first visit or a repeat visit to this Website?

FIRST VISIT REPEAT VISIT

INFORMATION:


  • CLICK ON THE "RADIO" BUTTON or "CHECKBOX" FOR EACH ANSWER
  • RECLICK TO CHANGE A RESPONSE SELECTION
  • PRESS THE "RESET" BUTTON TO REDO THE ENTIRE FORM
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Q.1 Is VIDEO OTOSCOPY applicable in your work / study?

YES NO
- - If NO, please skip to Q.6.

Q.2 Do you presently own or have access to VIDEO OTOSCOPY system(s) in your work / study

YES NO
- - If NO, please skip to Q.4

Q.3 List the Manufacturer(s) / Model(s) of VIDEO OTOSCOPY systems presently at your work / study site.

PORTABLE VO SYSTEMS (Check all that apply)
Number of portable VO systems:

A. GSI/Grason/Welch Allyn.
B. Interpersonal Communications.
C. Jed-Med (Direct).
D. Med-Optics.
E. MedRx.
F. Siemens.
G. Starkey / Star-Med.
H. "Home made" system.
I. Please indicate OTHER manufacturer(s):


FIXED SITE / CLINICAL VO SYSTEMS (Check all that apply)
Number of clinical VO systems:

A. GSI/Grason/Welch Allyn.
B. Interpersonal Communications.
C. Jed-Med (Direct).
D. Med-Optics.
E. MedRx.
F. Siemens.
G. Starkey / Star-Med.
H. "Home made" system.
I. Please indicate OTHER manufacturer(s):

Q.4 Do you or does your facility plan to purchase a VIDEO OTOSCOPE?

YES NO
- - If NO, please skip to Q.6.

Q.5 How soon is the VO System purchase anticipated?

A. Immediate
B. within 90 days
C. within 6 months
D. within 1 year
E. within 2 years

Q.6 Please indicate your professional status:

A. Audiologist, Dispensing.
B. Audiologist, Non-Dispensing.
C. ENT Physician
D. Primary Care Physician
E. Other Physician Specialty. Please specify:
F. Resident Physician Specialty area:
G. Hearing Aid Dealer/Specialist/Technician
H. Engineer
I. Computer Specialist
J. Other profession / occupation. Please specify:
K. Full-time Student. Please specify major area:
- - If you are a Full-Time Student, please skip to Q.12.

Q.7 Primary Professional / Occupational Responsibility

A. Clinical service
B. Hearing Aid dispensing
C. Teaching
D. Management / Supervision
E. Consulting
F. Programming
G. Other: Please specify:

Q.8 Primary Practice / Employment Setting

A. Audiology Private Practice
B. Physician / Medical Office
C. Hospital
D. University
E. Medical School
F. Community Comm/Dis. Center
G. Hearing aid dealership
H. Hearing aid manufacturer
I. Special Instrumentation manufacturer
J. Other employment site / context. Please specify:

Q.9 Highest Degree Presently Completed in Your Field

A. Associate / Professional Certificate
B. Baccalaureate
C. Professional (MD, DDS, D.O., P.E.etc.)
D. Masters
E. Doctoral

Q.10 Present Full- or Part-Time Degree Program

A. B.A. / B.S.
B. M.A. / M.S.
C. M.D.
D. Ph.D.
E. AU.D.
F. Ed.D.
G. Other. Please specify degree program:

Q.11 Reason for visiting AUDIOLOGY FORUM: VIDEO OTOSCOPY

A. Required "reading" for academic degree course work.
B. Recommended "reading" for academic degree course work.
C. Professional continuing education, hours to be used as self-monitored CEUs.
D. Professional continuing education WITHOUT CEUs.
E. General information.
F. Just browsing.
G. Other reason(s)

Please specify

Q.12 Would you be interested in receiving verified CEU /CME hours for studying the AUDIOLOGY FORUM: VIDEO OTOSCOPY material in a tutorial format? (CHECK ALL THAT APPLY)

A. NO
B. YES, for ASHA CEUs.
C. YES, for Audiology state licensing CEUs.
D. YES, for State hearing aid dispenser certification/licensing.
E. YES, for medical CME hours.
F. YES, for Au.D. distance learning.
G. Other reason(s)

Please specify

Please provide your overall ratings of AUDIOLOGY FORUM: VIDEO OTOSCOPY.

A. INFORMATION

B. IMAGES

C. CASE STUDIES

D. NAVIGABILITY

E. ACCESS TIME

COMMENTS AND SUGGESTIONS

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Thank you for taking the time and effort to respond.


Roy F. Sullivan, Ph.D.