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2-minute hearing questionnaire
Answer a few quick questions and find out which BLUEMOTH solution is right for you.
10
Questions
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1
What brings you here today?
Select all that apply to you
I'm looking for hearing aids
I'm looking for tinnitus treatment
I'm learning about hearing health
My hearing aids need service
I'm helping someone else
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2
Which of the following is most important to your relief?
Select all that apply to you
Improved sleep
Reduced tension, frustration, or irritability
Improved concentration
Improved work or family life
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3
What's your main motivation to improve your hearing?
*
This field is required.
Connect with my community through conversation.
Improve my mental health and wellbeing.
Protect my cognitive health.
Enjoy more of the media and hobbies I love.
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4
Do you currently wear hearing aids?
YES
NO
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5
How often do you wear your hearing aids?
More than half the day
Less than half the day
Only in specific instances
Rarely
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6
How long have you had your hearing aids?
less than 1 year
1-3 years
3-5 years
more than 5 years
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7
Has your hearing been tested in the last six months?
*
This field is required.
Yes, by a hearing care professional.
Yes, I took an online screening.
No, it has been longer than 6 months since my hearing was tested.
No, I've never had my hearing tested.
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8
Tell us about your hearing and lifestyle preferences, so we can fine-tune your recommendation. Select the statements that apply to you.
*
This field is required.
I enjoy an active lifestyle
I enjoy social events with large groups
I enjoy streaming media
I am frequently on the go
Sound clarity comes first for me
I find it challenging to hear in background noise
I prefer the most innovative tech with all the latest features
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9
Where should we send your hearing questionnaire results?
*
This field is required.
Tell us a little bit about yourself and we'll be in touch to discuss your hearing health needs.
Age Range
18-35
36-45
46-60
60-75
75+
Age Range
Age Range
18-35
36-45
46-60
60-75
75+
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10
Is there anything you would like to share about your hearing health?
Let us know if you have specific concerns we can help with!
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