Hearing Group Of New Mexico Hearing Survey

1

Do You Suspect That You Might Have Hearing Loss?* This field is required.

Yes

Unsure

Maybe

2

How would you rate your hearing currently?* This field is required.

Poor

Fair

Good

Excellent

3

How well do you hear when talking over the phone?* This field is required.

Poor

Fair

Good

Excellent

4

Do you find yourself turning the TV volume up higher than what others set it to?* This field is required.

Always

Often

Sometimes

Never

5

Do people ever point out that you have misunderstood something that was said?* This field is required.

Always

Often

Sometimes

Never

6

How well do you follow conversations when multiple people are talking at the same time?* This field is required.

Poor

Fair

Good

Excellent

7

Do you have trouble hearing in noisy environments, like restaurants or crowds?* This field is required.

Always

Often

Sometimes

Never

8

How well do you hear when someone talks to you in a soft voice or whisper?* This field is required.

Poor

Fair

Good

Excellent

9

Have you been exposed to excessive noise at work, loud music, firearms or other noisy hobbies?* This field is required.

Alway

Often

Sometimes

Never

10

Do you experience dizziness, pain or ringing in your ears?* This field is required.

Alway

Often

Sometimes

Never

11

All Done! * This field is required.Our team will be InTouch about your results and will help you discuss your next steps! We look forward to chatting with you.

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