Hearing Health Questionnaire

Hearing Health Questionnaire 2019-02-10T11:58:46+00:00

The onset of hearing loss is usually very gradual. It may take place over 25-30 years, or it may happen more rapidly if you are exposed to loud noises at work or through hobbies. Because it usually occurs slowly, you may not even be aware that you have a problem until someone brings it to your attention. Here is a simple test you can take to determine if you have a hearing loss.

1. Do others complain that you watch television with the volume too high? YesNo

2. Do you frequently have to ask others to repeat themselves? YesNo

3. Do you have difficulty understanding what is being said when in groups or noisy situations? YesNo

4. Do you have to sit up front in meetings, church or other social gatherings in order to hear a speaker’s words? YesNo

5. Do you have difficulty understanding women or young children? YesNo

6. Do you have trouble knowing where sounds come from? YesNo

7. Are you unable to understand when someone talks to you from another room? YesNo

8. Have others told you that you don’t seem to hear them? YesNo

9. Do you avoid family gatherings or social situations because you “can’t understand”? YesNo

10. Do you have ringing or other noises (tinnitus) in your ears? YesNo

Hearing health studies have shown that answering “yes” to ONE or more questions indicate a baseline audiogram should be established. Fill out the below form and we will contact you to schedule an appointment.

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