1. Do you find it difficult to follow conversation in a crowded room or restaurant?
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Yes
No |
2. Do you frequently ask people to speak up or repeat themselves?
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Yes
No |
3. Do you find yourself turning one ear toward a speaker to hear better?
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Yes
No |
4. Do you find it difficult to hear when listening on the phone?
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Yes
No |
5. Do you find children's voices difficult to hear?
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Yes
No |
6. Do you feel people are mumbling or not speaking clearly?
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Yes
No |
7. Do you have ringing in your ears?
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Yes
No |
8. Are you avoiding social activities because of your hearing?
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Yes
No |
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| If you answered "yes" to any of these questions, a hearing evaluation is recommended.
Please fill out your information below, to schedule a FREE hearing evaluation.
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| Name: |
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| Phone: |
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| E-mail: |
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Comments: |
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