Hearing Handicap Assessment

Welcome to our Hearing Handicap Assessment!

This assessment is used to help us understand your hearing needs and how you feel about your hearing in everyday situations. Answer Yes, No, or Sometimes for each question. Do not skip a question if you avoid a situation because of a hearing problem. If you use a hearing aid, please answer according to the way you hear with your aid.

Please leave us your contact information so we can help you hear better based on your results.

First Name

Last Name

Phone

Do you consider yourself tech-savy?

Does a hearing problem cause you to feel embarrassed when meeting new people?

Does a hearing problem cause you to feel frustrated when talking to members of your family?

Do you have difficulty hearing when someone speaks in a whisper?

Do you feel handicapped by a hearing problem?

Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors?

Does a hearing problem cause you to avoid groups of people?

Does a hearing problem cause you to have arguments with family members?

Does a hearing problem cause you difficulty when listening to TV or radio?

Do you feel that any difficulty with your hearing limits or hampers your personal or social life?

Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?