Scoring - Hearing Self-Assessment

1

Do you have a problem hearing over the telephone?

Yes

Sometimes

No

2

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

Yes

Sometimes

No

3

Do people often complain that your TV volume is too high?

Yes

Sometimes

No

4

Do you have to strain to hear conversations?

Yes

Sometimes

No

5

Do you have trouble hearing in noisy environments such as restaurants or parties?

Yes

Sometimes

No

6

Do you miss common sounds such as the phone or doorbell?

Yes

Sometimes

No

7

Do you have trouble locating where a sound is coming from?

Yes

Sometimes

No

8

Do you find yourself often asking people to repeat themselves?

Yes

Sometimes

No

9

Does your family or friends often make comments about missing what was said?

Yes

Sometimes

No

10

Do people seem to mumble?

Yes

Sometimes

No

11

Do you often misunderstand what others are saying?

Yes

Sometimes

No

12

Do you have trouble understanding the speech of women and children?

Yes

Sometimes

No

13

Do people get annoyed because you misunderstand what they say?

Yes

Sometimes

No

14

Do you avoid social activities for fear of not hearing conversations?

Yes

Sometimes

No

15

Name

First Name

Last Name

16

Would you like someone to contact you to answer questions about your hearing?

YESNO

17

Enter your email address and someone will contact you soon.

example@example.com

18

Calculation