The purpose of the self-test is to identify the problems a hearing loss may be causing. Print this page then answer either Yes, Sometimes, or No for each of the questions. Do not skip a question if you avoid a situation because of a hearing problem. See below for scoring.

Please read each question and check the box that applies to you.	Yes	Sometimes	No
Does a hearing problem cause you to feel embarrassed when meeting new people?
Does a hearing problem cause you to feel frustrated when talking to members of your family?
Do you have difficulty hearing when someone speaks in a whisper?
Do you feel handicapped by a hearing problem?
Does a hearing problem cause you difficulty when visiting with friends, relatives or neighbors?
Does a hearing problem cause you difficulty in the movies, the theater or when attending religious services?
Does a hearing problem cause you to have arguments with family members?
Does a hearing problem cause you difficulty when listening to TV or radio?
Do you feel that any difficulty with your hearing limits or hampers your personal or social life?
Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?

Using the scoring formula shown below calculate the total number of points scored

If you scored higher than 8 points on this questionnaire, it is highly recommended that you make an appointment for a hearing evaluation conducted by a professional hearing health care provider. If you suspect a hearing loss, call your doctor, or visit the Audiology Service Associates location nearest you. We can help!

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