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Hearing Survey
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Hearing Survey
Take our online hearing survey to see if you should schedule an appointment.
Name
*
Phone
*
Email
*
1. I have a problem hearing over the phone.
yes
no
2. I have trouble following the conversation when two or more people are talking at the same time.
yes
no
3. People complain that I turn the TV volume too high.
yes
no
4. I have to strain to understand conversations.
yes
no
5. I have trouble hearing conversations in a noisy background such as a party.
yes
no
6. I miss hearing some common sounds like the phone or doorbell ring.
yes
no
7. I get confused about where sounds come from.
yes
no
8. I misunderstand some words in a sentence and need to ask people to repeat themselves.
yes
no
9. I especially have trouble understanding the speech of women and children.
yes
no
10. I have worked in noisy environments.
yes
no
11. Many people mumble when they talk.
yes
no
12. People get annoyed because I misunderstand what is being said.
yes
no
13. I misunderstand what others are saying and make inappropriate responses.
yes
no
14. I avoid social activities because I cannot hear well and fear that I'll reply improperly.
yes
no
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