Evaluate Loved One's Hearing

Use the brief questionnaire below to see if your loved one may be experiencing some degree of hearing loss. Be sure to evaluate each question carefully and answer honestly to ensure an appropriate evaluation. The questionnaire represents only a portion of the actual evaluation questions HearUSA uses to establish a diagnosis and should not be used to determine a final course of action other than seeking further evaluation by a hearing care professional.

1. Do you feel a hearing problem causes him/her to feel embarrassed when meeting new people? YesSometimesNo
2. Have you observed a hearing problem causing him/her difficulty when visiting friends, relatives or neighbors? YesSometimesNo
3. Does a hearing problem cause him/her to feel frustrated when talking to members of their family? YesSometimesNo
4. Does a hearing problem cause him/her to have arguments with family members? YesSometimesNo
5. Have you observed a hearing problem causing him/her difficulty hearing/understanding coworkers, clients or customers? YesSometimesNo
6. Do you think he/she feels impaired by hearing problems? YesSometimesNo
7. Does a hearing problem cause him/her difficulty in the movies or theater? YesSometimesNo
8. Does a hearing problem cause him/her difficulty when listening to a radio or TV? YesSometimesNo
9. Have you observed a hearing problem causing him/her difficulty when in a restaurant? YesSometimesNo
10. Does he/she feel that difficulty with their hearing limits or hampers their personal life? YesSometimesNo