Listening Questionaire

Determining listening and lifestyle needs patient questionnaire.

Please select the response; seldom = 1 point, occassionally = 2 point, often = 3 point, which best describes your listening and lifestyle needs:

 1.  You are actively  working and need to communicate with many people throughout the day. 

 2.  You spend time at loud activities like sporting events or concerts where you need to hear in the presence of a great deal of background noise.

 3.  You attend large parties or go to busy restaurants.

 4.  You go shopping or spend time in public places where being able to communicate is important.

 5.  You are involved in religious gatherings where you need to be able to hear.

 6.  You attend work or social meetings where you need to be able to communicate.

 7.  You need to hear in quiet restaurants.

 8.  You need to be able to communicate in small group settings.

 9.  You need to be able to hear in one-on-one settings.

 10.  You spend quite a bit of time involved in quiet home activities.

Total the points to determine the hearing instrument technology level needed to enjoy your lifestyle.

Total:   10-15 = Quiet      16-22 = Moderate       23-30 = Demanding

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