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ABR and AEP Options
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Smart EP-ASSR Systems
SmartScreener Systems
Otoacoustic Emission Options
Smart DPOAE Systems
Smart TrOAE Systems
Audiometry Options
Intelligent VRA System
Manual VRA System
Video VRA System
SmartAudiometer System
Speech Options
LIPP Phonetics Program
CHATS Curriculum

Registration Form

Dear Customer,

Thank you for your order. Please read the Installation Section in the provided manuals to ensure proper operation of the system. Please take moment to fill out and send the following registration form in order to register and activate the system's warranty. The information provided in this form will help us to better understand our customers needs, allowing us to provide better products and services. It will also allow us to contact you about product updates and special offers. All contact information provided in this form is confidential and will never be shared with third parties.

Fill out and send this form within 10 days of receiving your system to extend your warranty period for 90 days.
General Information
Your Name*
(Person Filling Out Survey)
Date of System Delivery*
System Number*
Primary Contact Name*
Company Name *
Address*
Telephone Number*
Fax Number
E-Mail
Distributor
Purchase Date*
You are the...

Primary User
Buyer
Both
Which ONE statement best describes your role in the purchase process decision of this system:
No involvement
Some involvement
Made recommendation
Approved purchase
How did you hear of Intelligent Hearing Systems?
Please check all that apply.

Distributor
Professional Acquaintance
Journal
Workshop
Convention
Mailing
Web site

 Previous Experience with IHS
Where?


Other
What sources helped make the purchase decision?
(Please check all that apply)
Direct Mail piece
Product Literature
Worldwide Registry
Advance Magazine Ad
The Hearing Journal Ad
Exhibit / Trade Show
 Workshop
Salesperson / Distributor
Previous Experience with IHS
Colleague Recommendation
Web Page
Other
What are the top reasons for choosing this system?
Please rank the most important reasons, 1 being the most important
Reliability
Brand Name/Reputation
Warranty Offered
Price
Quality of System
Features/Capabilities
Repeat Customer
Integration
Ability to Upgrade

Product Review
Colleague's Recommendation
System Flexibility
Research Capability
Ease of Use
Quality of Recordings
Customer Service
Other:

What can we improve to make your purchase experience a more pleasant one?
Quicker follow up upon inquiry.
A more knowledgeable distributor.
More comprehensive media availability (info CD's, website, flyers)
Other:  
Did the system arrive at the time it was supposed to?
Yes No
The system arrived:
(Check all that apply)
In working order
Clean
Boxes in good condition
Release sheets accompanied each component
Were your questions answered during training?
All of my questions were answered during training
Most of my questions were answered during training
Half of my questions were answered during training
Barely any of my questions were answered during training
None of my questions were answered during training
No training was provided or requested
Was the staff friendly?
Very friendly
Friendly most of the time
Not Friendly, not unfriendly
Somewhat unfriendly
Very unfriendly
Are you able to contact the installation and training staff easily?
Yes
No
Not Applicable
What are some of the strong aspects of the installation and training staff and services provided?
(Check all that apply)
Professionalism
Knowledge of System
Punctuality
Friendliness and support
Not Applicable
Other:
What were some of the weak aspects of the installation and training staff and services provided?
Lack of professionalism
Lack of knowledge of system
Tardy
Unfriendly and unsupportive
Not Applicable
Other:
What can we improve in order to make your delivery and installation experience more pleasant?
Punctuality
Friendliness
Knowledge of System
Other:
Do you feel you have sufficient access to customer support?
Yes
 No
Is this the first Intelligent Hearing Systems System purchased?
Yes No, how many?
What type of system did you purchase?
(check all that apply)
SmartEP
SmartEP-ASSR
SmartDPOAE
SmartTrOAE
SmartScreener

PetScreener
Intelligent VRA
Manual VRA
Video VRA
SmartAudiometer
If you did not purchase a computer from Intelligent Hearing Systems, please provide us with the following information
Computer Brand:
Computer Type Laptop     Desktop
Operating System
PC Memory MB of RAM
Hard Drive Size GB HDD
Modem Installed? Yes No
If you purchased an Evoked Potential system, which tests are you planning to run?
(Please check all that apply)
ECochG
Click ABR
Pure tone ABR
Bone Conduction ABR
ASSR		 MLR
LLR
P300
MMN
Screening ABR or ASSR
How many people will use this system on a regular basis?
0 - 1
2 - 4		 5 - 10
10+
How many patients do you expect to test per week?
1 - 10
11 - 20
21 - 50		 51 - 100
101 - 200
201+
Did the system perform as expected?

Yes
Don't Know
No, please explain

What is your favorite feature?
(Check all that apply)
Windows -Based
Report Generation
Database Capability
Ease of Calibration 		Integration
Ability to Upgrade
USB Plug&Play platform
Other
What is your least favorite feature?
What are the applications for this system?
(Check all that apply)
Infant Screening in NICU
Screening in Well Baby Nursery
Infant Screening Follow up
Diagnostics
 Teaching Tool
Research
Animal Research
Which of the following describes best where the system is being used?

Private Practice (# of employees)
1 -19
20 - 49
50 - 100
101 and over

Government Clinic
State/Local
Federal

Hospital
Audiology Department
Otolaryngology Department
Well Baby Nursery
Neonatal Intensive Care

Educational Institution
School of the Deaf
K - 12
University - used for teaching
University - used for research
Would you recommend Intelligent Hearing Systems to your friends and professional acquaintances?
Yes No, Why:
Would you purchase another Intelligent Hearing Systems product, should the need arise?
Yes No, Why:
Please evaluate Intelligent Hearing Systems' quality and performance
 
< - Satisfied
Dissatisfied - >
Product Literature
Customer Service
Delivery Time
Quality of Packaging/Delivery
Operator's Manual
Product met initial expectations
Please evaluate the distributors performance
 
< - Satisfied
Dissatisfied - >
Information provided
In-Service/Installation
Training
Knowledge of the System
Timely Service
Please rate the overall experience of buying from Intelligent Hearing Systems
 
< - Satisfied
Dissatisfied - >
Overall Rating

 

Enter any additional comments here:

 
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