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Do you find it difficult to follow a conversation in a noisy restaurant or crowded room?YesNoSometimes

Do you sometimes feel that people are mumbling or not speaking clearly?YesNoSometimes

Do you experience difficulty following dialog in the theater?YesNoSometimes

Do you sometimes find it difficult to understand a speaker at a public meeting or a religious service?YesNoSometimes

Do you find yourself asking people to speak up or repeat themselves?YesNoSometimes

Do you find men’s voices easier to understand than women’s?YesNoSometimes

Do you experience difficulty understanding soft or whispered speech?YesNoSometimes

Do you have difficulty understanding speech on the telephone?YesNoSometimes

Does a hearing problem cause you to feel embarrassed when meeting new people?YesNoSometimes

Do you feel handicapped by a hearing problem?YesNoSometimes

Does a hearing problem cause you to visit friends, relatives, or neighbors less often than you would like?YesNoSometimes

Do you experience ringing or noises in your ears?YesNoSometimes

Do you hear better with one ear than the other?YesNoSometimes

Have you had any significant noise exposure during work, recreation, or military service?YesNoSometimes

Have any of your relatives (by birth) had a hearing loss?YesNoSometimes