SCORE YOUR HEARING!

Answer either Yes (Y), No (N), or Sometimes (S) for each of the following questions...

1.  Does a hearing problem cause you to feel embarrassed when meeting new people?  Yes   No   Sometimes

2.  Does a hearing problem cause you to feel frustrated when talking to members of your family?   Yes   No   Sometimes

3.  Do you have difficulty hearing when someone speaks in a whisper?   Yes   No   Sometimes

4.  Do you feel handicapped by a hearing problem?   Yes   No   Sometimes

5.  Does a hearing problem cause you difficulty when visiting friends, relatives or neighbors?   Yes   No   Sometimes

6.  Does a hearing problem cause you to attend religious services less often than you would like?   Yes   No   Sometimes

7.  Does a hearing problem cause you to have arguments with family members?   Yes   No   Sometimes

8.  Does a hearing  problem cause you difficulty when listening to TV or radio?   Yes   No   Sometimes

9.  Do you feel any difficulty with your hearing limits or that it hampers your personal or social life?   Yes   No   Sometimes

10.Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?   Yes   No   Sometimes

Scoring:  Yes is worth 4       Sometimes is worth 2       No is worth 0

Total Score:  (If you scored 18 or greater a hearing evaluation is recommended).

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