HEARING SCREENING QUESTIONNAIRE
HOW MANY APPLY TO YOU?
- I have to strain to hear conversations.
- I have trouble following the conversation when two or more people are talking at the same time.
- I miss hearing some common sounds like the phone or doorbell ringing.
- I sometimes get confused about where sounds come from.
- I have trouble hearing over the telephone.
- I have trouble hearing conversations in a noisy background such as at a party.
- People complain that I turn the TV volume too high.
- I misunderstand some words in a sentence and need to ask people to repeat themselves.
- I especially have trouble understanding the speech of women and children.
- I have worked in noisy environments (assembly lines, jackhammers, jet engines, etc.).
- Many people I talk to seem to mumble or do not speak clearly.
- People get annoyed because I misunderstand what they say.
- I misunderstand what others are saying and make inappropriate responses.
- I avoid social activities because I cannot hear well and fear I may reply improperly.
- To be answered by a family member or friend: Do you think this person has a hearing loss?
If 4 OR LESS apply: No action required.
If 4 OR MORE apply: Schedule a hearing evaluation. Call us at 250-635-HEAR 250-635-4327 1-800-811-1533
This is a screening mechanism only and should not be considered a substitute for an audiologic evaluation.