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Hearing Test

If you want to talk to us about your results fill out this information, take the test
and click send information at the bottom.
Name:
Phone#:
E-mail:

Scoring:
Score 2 points for Yes
Score 1 point for Sometimes and
Score 0 points for No

 
Scores of 3 or more may mean that you have a hearing problem. Score of 6 or more strongly suggest that a hearing check is warranted. In either case, ask your doctor to screen your hearing. Further testing by an audiologist may be recommended.
 
1. Did you find it difficult to follow a conversation in a noisy restaurant or crowded room?
Yes No Sometimes
2. Do you sometimes feel that people are mumbling or not speaking clearly?
Yes No Sometimes
3. Do you experience difficulty following dialog in the theater?
Yes No Sometimes
4. Do you sometimes find it difficult to understand a speaker at a public meeting or a religious service?
Yes No Sometimes
5. Do you find yourself asking people to speak up or repeat themselves?
Yes No Sometimes
6. Do you find men's voices easier to understand than women's?
Yes No Sometimes
7. Do you experience difficulty understanding soft or whispered speech?
Yes No Sometimes
8. Do you sometimes have difficulty understanding speech on the telephone?
Yes No Sometimes
9. Does a hearing problem cause you to feel embarrassed when meeting new people?
Yes No Sometimes
10. Do you feel handicapped by a hearing problem?
Yes No Sometimes
11. Does a hearing problem cause you to visit friends, relatives or neighbors less often than you would like?
Yes No Sometimes
12. Do you experience ringing or noises or ringing in your ear.
Yes No Sometimes
13. Do you hear better with one ear than the other?
Yes No Sometimes
14. Have you had any significant noise exposure during work, recreation r military service?
Yes No Sometimes
15. Have any of your relatives (by birth) had a hearing loss?
Yes No Sometimes

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7396 Center Ave . Huntington Beach, CA 92647 . 714.903.9857
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