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Please answer each question below to the best of your ability. When you click submit, we will review the results and contact you to discuss any hearing issues you may be having.

Do you have to strain to understand conversations?

Almost Always

Half the Time

Occasionally

Never

Are there situations in which you find it difficult to hear clearly?

Almost Always

Half the Time

Occasionally

Never

Do you have a problem hearing over the telephone?

Almost Always

Half the Time

Occasionally

Never

Do you have trouble following a conversation when two or more people are talking at the same time?

Almost Always

Half the Time

Occasionally

Never

Do you have trouble hearing conversations in a noisy background such as a restaurant or a group gathering?

Almost Always

Half the Time

Occasionally

Never

Do you have dizziness, pain, or ringing in your ears?

Almost Always

Half the Time

Occasionally

Never

Do family members or coworkers remark about your missing what has been said?

Almost Always

Half the Time

Occasionally

Never

Do you find it hard to hear someone when they talk in a soft voice or whisper?

Almost Always

Half the Time

Occasionally

Never

Do you find understanding women and children particularly challenging?

Almost Always

Half the Time

Occasionally

Never

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