Online Hearing Test Name (required) Email (required) 1. I have a problem hearing over the phone. Almost Always Half the Time Occasionally Never 2. I have trouble following the conversation when two or more people are talking at the same time. Almost Always Half the Time Occasionally Never 3. People complain that I turn the TV volume too high. Almost Always Half the Time Occasionally Never 4. I have to strain to understand coversations. Almost Always Half the Time Occasionally Never 5. I have trouble hearing conversations in a noisy background such as a party. Almost Always Half the Time Occasionally Never 6. I miss hearing some common sounds like the phone or doorbell ring. Almost Always Half the Time Occasionally Never 7. I get confused about where sounds come from. Almost Always Half the Time Occasionally Never 8. I misunderstand some words in a sentence and need to ask people to repeat themselves. Almost Always Half the Time Occasionally Never 9. I especially have trouble understanding the speech of women and children. Almost Always Half the Time Occasionally Never 10. I have worked in noisy environments. Almost Always Half the Time Occasionally Never 11. Many people mumble when they talk. Almost Always Half the Time Occasionally Never 12. People get annoyed because I misunderstand what is being said. Almost Always Half the Time Occasionally Never 13. I misunderstand what others are saying and make inappropriate responses. Almost Always Half the Time Occasionally Never 14. I avoid social situations because I cannot hear well and fear that I'll reply improperly. Almost Always Half the Time Occasionally Never To be answered by a family member: 15. Do you think this person has a hearing loss? Almost Always Half the Time Occasionally Never 16. Do you have a blood relative with hearing loss? Almost Always Half the Time Occasionally Never Leave this field blank
