1) Do you believe you may be experiencing hearing loss? Yes Unsure No None 2) How would you rate your hearing currently? Poor Fair Good Excellent None 3) How well do you hear when talking over the phone? Poor Fair Good Excellent None 4) Do you find yourself turning the TV volume up higher than what others set it to? Always Often Sometimes Never None 5) Do people ever point out that you have misunderstood something that was said? Always Often Sometimes Never None 6) How well do you follow conversations when multiple people are talking at the same time? Poor Fair Good Excellent None 7) Do you have trouble hearing in noisy environments, like restaurants or crowds? Always Often Sometimes Never None 8) How well do you hear when someone talks to you in a soft voice or whisper? Poor Fair Good Excellent None 9) Have you been exposed to excessive noise at work, loud music, firearms or other noisy hobbies? Always Often Sometimes Never None 10) Do you experience dizziness, pain or ringing in your ears? Always Often Sometimes Never None 1 out of 10 Name Email Time's up
