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Hearing Healthcare Screening Questionnaire for Adults
1 / 10
1) Does a hearing problem cause you to feel embarrassed when you meet new people?
2 / 10
2) Does a hearing problem cause you to feel frustrated when talking to family members?
3 / 10
3) Do you have difficulty hearing or understanding co-workers, clients or customers?
4 / 10
4) Do you feel handicapped by a hearing problem?
5 / 10
5) Does a hearing problem causeyou difficulty when visiting friends, relatives or neighbors?
6 / 10
6) Does a hearing problem cause you difficulty in the movies or in the theater?
7 / 10
7) Does a hearing problem cause you to have arguments with family members?
8 / 10
8) Does a hearing problem cause you difficulty when listening to TV or radio?
9 / 10
9) Does lack of hearing hamper your personal or social life?
10 / 10
10) Does a hearing problem cause you difficulty when in a restaurant with friends?
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Adapted from: Ventry, I., Weinstein, B. “Identification of elderly people with hearing problems”.American Speech-Language-Hearing Association. 1983, 25, 37-42.