Microsuction Questionnaire

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Please rate the following in the range of one (poor) and five (excellent)

Ease of getting a convenient appointment: *

Ease of checking in when you arrived at the surgery: *

Advice provided by the clinician: *

Care provided to you by the clinician: *

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Please answer the following

Did you receive adequate information beforehand about the procedure, including written information: *

Was the efficacy, possible risks/side-effects explained to you fully by the clinician: *

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Please rate any pain/discomfort you felt during or soon after microsuction using a scale of 1 (severe pain) to 5 (minimal pain)

During the procedure: *

In the first few days after the procedure: *

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Using a scale of 1 (little or no improvement) to 5 (significant improvement) what level of impact did microsuction have on your hearing

Impact on your hearing: *

Did you see your GP for any reason arising from the procedure: *

Overall, please rate the microsuction service, using a scale of 1 (poor) to 5 (excellent): *

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