Self Evaluation

To determine your level of hearing loss, answer the following questions:

Question 1: Never Sometimes Always	1. Do you find it difficult to hear and understand at social gatherings?
Question 2: Never Sometimes Always	2. Do you have difficulty conversing on the telephone?
Question 3: Never Sometimes Always	3. Do you turn the television up louder than others like it?
Question 4: Never Sometimes Always	4. Does your hearing loss cause you to feel embarrassed?
Question 5: Never Sometimes Always	5. Does your hearing loss cause arguments within your family?
Question 6: Never Sometimes Always	6. Do you feel as though others mumble?
Question 7: Never Sometimes Always	7. Do you have difficulty hearing at church?
Question 8: Never Sometimes Always	8. Do you ask people to repeat what they have said?
Question 9: Never Sometimes Always	9. Do you feel stressed or tired when you listen for long periods?
Question 10: Never Sometimes Always	10. Do you have difficulty hearing at work?
Question 11: Never Sometimes Always	11. Do your hear but not understand?
Question 12: Never Sometimes Always	12. Do you find it difficult to hear in the presence of background noise?
Question 13: Never Sometimes Always	13. Do you have difficulty hearing in movies or at the theater?
Question 14: Never Sometimes Always	14. Are loud sounds too loud for you?
Question 15: Never Sometimes Always	15. Do you have difficulty with women's and children's voices?
Question 16: Never Sometimes Always	16. Do you have difficulty following a conversation around the dinner table?
Question 17: Never Sometimes Always	17. Do you try to avoid social functions?

If you answered sometimes or always at least seven times combined, you may be experiencing a hearing loss that might be assisted by the use of hearing devices.

Print out this form and contact us us today to schedule an appointment.

 

HEARING TEST DISCLAIMER: This self-test questionnaire is not intended to take the place of an audiological examination. It is offered to you strictly as a guideline to help you determine whether or not you are experiencing signs and symptoms consistent with hearing loss. If you suspect you have hearing loss in one or both ears, or any problems with your ears or hearing, we strongly recommend that you see a hearing healthcare professional. We suggest that you print this test and your responses and review them with your hearing healthcare professional.