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Part 1: Assistive Tech Survey

Questions 1–10
Complete the notes below.
Write ONE WORD AND/OR A NUMBER for each answer.

Assistive technology survey

Name: Lina Petrov
Client reference: [1] ____________________

Device details
Type of device: digital hearing [2] ____________________
Preferred language for messages: [3] ____________________

Problem
Problem noticed: [4] ____________________ noise
Problem happened most on the [5] ____________________ side

After-service information
Item returned by: [6] ____________________
Amount paid: [7] £ ____________________
Repair time: [8] ____________________ days

Follow-up
Best day for follow-up call: [9] ____________________
Online review takes about [10] ____________________ seconds