Country Roads Audiology Hearing Quiz

1

Do you feel there are situations where you find it challenging to hear as well as you would like?* This field is required.

Almost Always

Half the Time

Occasionally

Never

2

Do family members, friends or coworkers ever tell you that you are not hearing well or that you are missing hearing what has been said?* This field is required.

Almost Always

Half the Time

Occasionally

Never

3

Do you have difficulty following a conversation when there are multiple people talking at the same time?* This field is required.

Almost Always

Half the Time

Occasionally

Never

4

Do you find it challenging to hear in a noisy environment like a restaurant?* This field is required.

Almost Always

Half the Time

Occasionally

Never

5

Does anyone ever tell you that you turn the TV up too loud?* This field is required.

Almost Always

Half the Time

Occasionally

Never

6

Do you ever experience ringing or other noises in your ears?* This field is required.

Almost Always

Half the Time

Occasionally

Never

7

Do you ever experience dizziness?* This field is required.

Almost Always

Half the Time

Occasionally

Never

8

Do you find it challenging to hear on the telephone?* This field is required.

Almost Always

Half the Time

Occasionally

Never

9

Do you find yourself avoiding certain situations because you know you will have a hard time hearing as well as you would like?* This field is required.

Almost Always

Half the Time

Occasionally

Never

10

Do you ever feel embarrassed that you have misunderstood or not heard something?* This field is required.

Almost Always

Half the Time

Occasionally

Never

11

Fill out the following information for your score.

12

Name* This field is required.

First Name

Last Name

13

Phone Number* This field is required.

Area Code

Phone Number

14

Email* This field is required.

example@example.com

15

Score