Advanced Audiology Concepts
 

Hearing Questionaire

(say what?)

Here's a simple questionaire to help you determine if you need some attention from our Audiologist.  If you'd like, you can submit the form to our office at the end of the questionaire with your name and phone number and we'll get back with you as soon as possible!

My hearing is . . .
Does it seem that women and children mumble?
Do others tell you that you’re not hearing them?
Is it difficult to understand some voices?
Do you hear ringing in one or both ears?
Have you ever worked in a loud environment? Factory Kitchen Landscaping Airport Firefighting
Musician Weapons Discharge Amusement Park Raised a Family of Children! *S* Nagging husband/wife! *S*
Other
Do you ask others to repeat themselves?
Do you pretend to understand what others say?
Does your family complain that the TV is too loud?
Are there any family members with hearing problems
Do you have difficulty hearing in crowds?
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