Capital Hearing Services

Hearing Self-Check

Do you think you have a hearing loss?

Would you like to know how to take that first step towards correction?

There are several questions you can answer which may indicate some loss of hearing

1. I have difficulty		Always
hearing in a group of		Almost Always
people.		Sometimes
		Almost Never
		Never


2. I hear people speak,		Always
but have difficulty		Almost Always
understanding the		Sometimes
words.		Almost Never
		Never


3. I have difficulty		Always
hearing on the		Almost Always
telephone.		Sometimes
		Almost Never
		Never


4. I set the volume on		Always
the television louder		Almost Always
than others would like.		Sometimes
		Almost Never
		Never


5. I have trouble hearing		Always
in church, at the		Almost Always
movies and		Sometimes
in other public places.		Almost Never
		Never


6. I have difficulty		Always
hearing children speak.		Almost Always
		Sometimes
		Almost Never
		Never


7. I can not hear a digital		Always
watch or alarm clock		Almost Always
beep.		Sometimes
		Almost Never
		Never


8. I have to ask friends		Always
and family to repeat		Almost Always
what they say.		Sometimes
		Almost Never
		Never


9. I have trouble		Always
following a		Almost Always
conversation with 2 or		Sometimes
more people involved.		Almost Never
		Never


10. I find it hard to		Always
determine the		Almost Always
direction from where		Sometimes
the sound is coming		Almost Never
from.		Never


11. I find myself avoiding		Always
social events.		Almost Always
		Sometimes
		Almost Never
		Never


12. I get complaints that		Always
I misunderstand what		Almost Always
people say to me.		Sometimes
		Almost Never
		Never


13. I find myself asking		Always
people to speak more		Almost Always
clearly.		Sometimes
		Almost Never
		Never


14. I have worked in		Always
places where there		Almost Always
were loud noises		Sometimes
(airports, heavy		Almost Never
equipment)		Never


15. I reply to people		Always
inappropriately		Almost Always
because I		Sometimes
misunderstand what		Almost Never
they say.		Never


I have a hearing aid		Yes
		No

I have had this hearing		Less than a year
aid for		1 to 5 years
		More than 5 years

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