Service evaluation survey questionnaire

Name:Date of birth: Duration of tinnitus: …… (years) Tinnitus: Yes/No Hyperacusis: Yes/NoHearing Loss: Yes/No
Please rank the effect of the treatments you received at the Royal Surrey County Hospital, with regard to the management of your tinnitus or hyperacusis. If you feel that you have not received a treatment, then leave that question blank.
1. Hearing tests
1 (no effect)	2	3	4	5 (very effective)
2. Completing questionnaires
1 (no effect)	2	3	4	5 (very effective)
3. Education and Information about your ears as well as tinnitus/hyperacusis
1 (no effect)	2	3	4	5 (very effective)
4. counselling (i.e. therapists listening empathically to your concerns and story)
1 (no effect)	2	3	4	5 (very effective)
5. Cognitive behavioural therapy (i.e. therapist working collaboratively with you to help modifying negative thoughts and feeling about tinnitus/hyperacusis)
1 (no effect)	2	3	4	5 (very effective)
6. Bedside sound generator
1 (no effect)	2	3	4	5 (very effective)
7. White noise generator
1 (no effect)	2	3	4	5 (very effective)
8. Hearing aids (if you have hearing loss too)
1 (no effect)	2	3	4	5 (very effective)
9. Overall satisfaction from the tinnitus/hyperacusis clinic
1 (no effect)	2	3	4	5 (very effective)