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Dennis Hampton, Ph.D, CCC-A,


Keith E. Hampton,

Subscriber Services

280 Mamaroneck Avenue, Suite 204

White Plains, NY 10605

Toll Free (800) 342-1643

FAX (914) 761-2372

Compare: Score_________

This questionnaire is designed to help you assess the services you provide after , a hearing
instrument fitting. In your office do you (pick the appropriate response):

90-100% Great !!
80- 85% Good patient services
70-75% Room for improvement
Less than 70%: What an opportunity!

The Practice Development Program provides you with ready-to-use tools and
techniques developed from our work with successful audiologists for the past 18 years.

Press the submit button below if you would like more information that can help you
improve your follow-up care services, or contact us at 800-342-1643 (fax 914-761-2372)
or e-mail your request to