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5 Minute Hearing Test

    Almost Always Half the time Occasionally Never
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

    YES NO    
15. Do you think this person has a hearing loss?    
16. Do you have a blood relative with hearing loss?    

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