Online Hearing Test

5-MINUTE HEARING SURVEY

#TestAlmost AlwaysHalf the timeOccasionallyNever
1 I have a problem 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 of 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 are saying 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? ....

Please fill in the above form. Every answer will help.