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CEDRA Form
CEDRA Form
This questionnaire is designed to help you decide if you need to see a doctor before obtaining a hearing device. If you have any medical questions or concerns about your hearing, you should see a doctor no matter what your score is on this questionnaire
34Questions
CEDRA Form
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  • English (US)
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  • 1
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  • 3
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  • 4
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  • 5
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  • 6
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  • 14
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  • 15
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  • 16

    Do you have any of the following symptoms with your tinnitus?

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  • 17
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  • 18
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  • 19
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  • 20
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  • 21

    Have you ever had any of the following symptoms lasting longer than 10 minutes?

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  • 22
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  • 23
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  • 24

    In the past 3 months, have you had any of the following symptoms?

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  • 30
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  • 32
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  • 33

    On the next page if your score is 4 or higher, you should talk to your doctor about your symptoms.

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  • 34
    If 4 or higher, you should talk to your doctor about your symptoms prior to visiting us.
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