Hearing health questionnaire

ear image

Discover your next steps to better hearing

Answer a few short questions and you'll be directed to a page with more information regarding your responses.

5 minutes

4 questions

Which sounds like your experience?

Select one option

Have you been diagnosed with hearing loss?

Select one option

How would you describe your hearing loss?

Select one option

In which of these situations do you want to hear better?

Select all that apply

    • How often do you turn up the TV or ask people to repeat what they say?

    Select one option

    Do you ever have ringing, humming, or clicking in your ears?

    Select one option

    Is it ever difficult to hear in a loud restaurant or a crowded room?

    Select one option

    Have you been diagnosed with hearing loss?

    Select one option

    How would you describe your hearing loss?

    Select one option

    In which of these situations do you want to hear better?

    Select all that apply

    How often do you turn up the TV or ask people to repeat what they say?

    Select one option

    Why are you interested in getting hearing aids?

    Select all that apply

    How comfortable are you with technology like smartphones/tablets and video calling or texting?

    Select one option

    Has your loved one been diagnosed with hearing loss?

    Select one option

    Does your loved one have hearing aids?

    Select one option

    At what level is your loved one's hearing loss?

    Select one option

    Questionnaire Complete Image

    Thank you for completing the questionnaire!

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