Hearing Loss Questionaire

Answering “Yes” to three or more questions strongly suggests that a hearing evaluation is warranted. If you’d like to, you can submit your questionnaire below and our office will follow up with further information.

Note: Requests placed through our website portal are not encrypted.

Do you have a problem hearing over the telephone?

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

Do you have to strain to understand conversation?

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

Do people complain that you turn the TV volume up too high?

Do you have trouble hearing in a noisy background?

Do you find yourself asking people to repeat themselves?

Do people get annoyed because you misunderstand what they say?

Do many people you talk to seem to mumble (or not speak clearly)?

Do you misunderstand what others are saying and respond inappropriately?