Hearing Loss Questionnaire

Symptoms of Hearing Loss

In the U.S. alone, an estimated 30 million people have some form of hearing loss. The inability to comprehend speech and other sounds can strike at any time and at any age. It can be temporary or permanent, mild or profound. Hearing is an integral part of the human experience and when it is diminished, it affects all aspects of that experience.

Luckily modern technological advances in Hearing Science have improved the quality of life for many individuals. A hearing test provided by a trained hearing health specialist is the first step in rehabilitating their communication ability and reuniting them with their world.

Do you have any of the following volume, clarity or pitch issues?

  • You turn the volume on the TV up. Others ask you to turn it down.
  • People’s voices often sound mumbled or muffled.
  • You struggle to hear women and children more than others.
  • You have problems hearing faint noises.
  • You hear ringing or buzzing noises that no one else does.

Have you found yourself in any of these situations?

  • You find yourself saying ‘come again?’ and ‘what?’ more frequently.
  • You let phone calls go to voicemail so you won’t have to struggle through the conversation.
  • You feel nervous about trying to hear and understand people.
  • You smile and nod to pretend you’re following the conversation at a crowded restaurant.
  • You’ve stopped taking part in activities you love because of your hearing loss.
  • Meeting new people has become stressful because you worry you won’t understand what they’re saying.
  • You feel people getting frustrated with you when you ask them to repeat themselves.

Do any of these health or noise exposure issues apply to you?

  • Exposure to a single, explosive noise
  • Exposure to very loud sounds over a long period of time
  • High blood pressure, heart or circulation issues
  • Dementia
  • Diabetes or recent strokes

If you answered YES to any of these questions, please contact our office to schedule an appointment with one of our certified audiologists.

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The purpose of this hearing assessment and/or demonstration is for hearing wellness to determine if the client(s) may benefit from using hearing aids. Products demonstrated may differ from products sold. Test conclusion may not be a medical diagnosis. The use of any hearing aid may not fully restore normal hearing and does not prevent future hearing loss. Testing is to evaluate your hearing wellness, which may include selling and fitting hearing aids. Hearing instruments may not meet the needs of all hearing-impaired individuals. One offer per customer. Insurance benefit, including Managed Care or federal reimbursements, cannot be combined with any of our promotional offers, coupons or discounts. Other terms may apply. See office for details.