Hearing Questionnaire

		Almost Always	Half the time	Occasionally	Never
1.	I have problems hearing over the phone.
2.	I have trouble following the conversation when two or more people are talking at the same time.
3.	People complain that I turn the TV volume too high.
4.	I have to strain to understand conversations.
5.	I have trouble hearing conversations in a noisy background such as a party.
6.	I miss hearing some common sounds like the phone or doorbell ring.
7.	I get confused about where sounds come from.
8.	I misunderstand some words in a sentence and need to ask people to repeat themselves.
9.	I especially have trouble understanding the speech women and children.
10.	I have worked in noisy environments.
11.	Many people mumble when they talk.
12.	People get annoyed because I misunderstand what is being said.
13.	I misunderstand what others a essaying and make inappropriate responses.
14.	I avoid social activities because I cannot hear well and fear that I'll reply improperly.
To be answered by a family member
15.	Do you think this person has a hearing loss?
16.	Do you have a blood relative with hearing loss?	yes	no

		Your Score

What does this mean?
Score	Analysis
0-5	Your hearing is good
6-9	Suggest a hearing evaluation
10 and above	Strongly recommend a hearing evaluation

If you scored above 6, we suggest that you receive a hearing evaluation.
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225 Wilmington - West Chester Pike, Suite 300
Chadds Ford, PA 19317
800.984.3272