Hearing Survey – Colorado West Audiologists

Hearing Screening Survey

Our online hearing questionnaire can help you better understand your hearing health.

Getting started is easy:

"*" indicates required fields

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This field is for validation purposes and should be left unchanged.

Do you believe you may be experiencing hearing loss?*

No	Unsure	Yes

How would you rate your hearing currently?*

Poor	Fair	Good	Excellent

How well do you hear when talking over the phone?*

Poor	Fair	Good	Excellent

Do you find yourself turning the TV volume up higher than what others set it to?*

Always	Often	Sometimes	Never

Do people ever point out that you have misunderstood something that was said?*

Always	Often	Sometimes	Never

How well do you follow conversations when multiple people are talking at the same time?*

Always	Often	Sometimes	Never

Do you have trouble hearing in noisy environments, like restaurants or crowds?*

Always	Often	Sometimes	Never

How well do you hear when someone talks to you in a soft voice or whisper?*

Always	Often	Sometimes	Never

Have you been exposed to excessive noise at work, loud music, firearms or other noisy hobbies?*

Always	Often	Sometimes	Never

Do you experience dizziness, pain or ringing in your ears?*

Always	Often	Sometimes	Never