compliance.asp
 

International: +305-668-6102  
US and Canada: 1-800-447-9783  
Fax: +305-668-6103 • E-mail: sales@ihsys.com  

Registration

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 a moment to complete and send the following registration form in order to register and activate your system's warranty. The information provided in this form will help us to better understand your needs and improve the quality of our 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 strictly confidential and will never be shared with third parties.


Extend your warranty 90 days by filling out our survey and sending it within 10 days of receiving your system.


Registration Form
General Information
Your Name*
(Person Filling Out Survey)
Your name is required.
Date of System Delivery*
Please enter as mm/dd/yyyy.
Date of delivery is required.
System Number*
A valid system number is required.
The system number is not complete.
Primary Contact Name*
A primary contact is required.
Company Name *
A company name is required.
Address*
The mailing address is required.
Telephone Number*
A phone number is required.
Fax Number
E-Mail
Distributor
Purchase Date*
The purchase date is required.
Invalid format.
1. Are you the...

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

Distributor
Professional Acquaintance
Journal
Workshop
Convention
Mailing
Web site
Search Engine

 Ad in publication
Buyer's Guide
Previous Experience with IHS
Explain?


Other
4. What sources helped make the purchase decision?
(Please check all that apply)
Direct Mail piece
Product Literature
Worldwide Registry
Magazine or Journal Ad
Exhibit / Trade Show
 Workshop
Salesperson / Distributor
Previous Experience with IHS
Colleague Recommendation
Web Page
Other
5. What publications does your institution or practice read frequently?
(Please check all that apply)
The Hearing Review
Audiology Today
ASHA Leader
Int. Journal of Audiology
 Other
6. Are you a member of an audiological organization?
7. What conferences have you attended in the last 5 years?
8. 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
Frequent Customer
Integration
Ability to Upgrade

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

9. What can we improve to make your next purchase experience more pleasant?
Quicker follow up upon inquiry.
A more knowledgeable distributor.
More comprehensive media availability (info CD's, web site, flyers)
Other:  
10. Did your system arrive at the time it was supposed to?
Yes No
11. The system arrived:
(Check all that apply)
In working order
Clean
With boxes in good condition
With release sheets accompanying each component
12. 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
13. Was the staff friendly?
Very friendly
Friendly most of the time
Apathetic
Somewhat unfriendly
Very unfriendly
14. Were you able to contact the installation and training staff easily?
Yes
No
I did not attempt to contact the installation & training staff
15. What are some of the strong aspects of the installation and training services provided?
(Check all that apply)
Professionalism
Knowledge of System
Punctuality
Friendliness and support
Not applicable
Other:
16. What were some of the weak aspects of the installation and training services provided?
Lack of professionalism
Lack of knowledge of system
Tardiness
Unfriendly and unsupportive staff
Not applicable
Other:
17. What can we improve in order to make your next delivery and installation experience more pleasant?
Punctuality
Friendliness
Knowledge of System
Other:
18. Do you feel you have sufficient access to customer support?
Yes
 No
19. Is this the first IHS System you have purchased?
No, how many? Yes
20. What type of system did you just purchase?
(check all that apply)
SmartEP
SmartEP-ASSR
SmartDPOAE
SmartTrOAE
SmartScreener-Plus 2

PetScreener
Intelligent VRA
Manual VRA
Video VRA
SmartAudiometer
21. If you purchased an Evoked Potential system, which tests are you planning to run with your new system?
(Please check all that apply)
ECochG
Click ABR
Pure tone ABR
Bone Conduction ABR
MLR
LLR
ASSR
 P300
MMN
Visual EP
Somatosensory
Screening ABR or ASSR
22. How many people will use your system on a regular basis?
0 - 1
2 - 4		 5 - 10
10+
23. How many patients do you expect to test per week?
1 - 10
11 - 20
21 - 50		 51 - 100
101 - 200
201+
24. Did the system perform as expected?

Yes
Don't Know
No, please explain

25. What are your favorite features of this system?
(Check all that apply)
Windows -Based
Report Generation
Database Capability
Ease of Calibration 		Integration
Ability to Upgrade
USB Plug&Play platform
Other
26. What is your least favorite feature? if any
27. 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
28. 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
29. Would you recommend Intelligent Hearing Systems to your professional acquaintances?
Yes No, Why not?:
30. Would you purchase another Intelligent Hearing Systems product, should the need arise?
Yes No, Why not?:
31. Please evaluate Intelligent Hearing Systems' quality and performance in the following areas:
 
< - Satisfied
Dissatisfied - >
Product Literature
Customer Service
Delivery Time
Quality of Packaging/Delivery
Operator's Manual
Product meeting initial expectations
32. Please evaluate the distributors performance in the following areas:
 
< - Satisfied
Dissatisfied - >
Information provided
In-Service/Installation
Training
Knowledge of the System
Timely Service
33. Please rate the overall experience of purchasing a system from Intelligent Hearing Systems
 
< - Satisfied
Dissatisfied - >
Overall Rating

 

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