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

Yes
No
Sometimes

Does a hearing problem cause you to feel frustrated when talking to members of your family?

Yes
No
Sometimes

Do you have difficulty hearing when someone speaks in a whisper?

Yes
No
Sometimes

Do you feel handicapped by a hearing problem?

Yes
No
Sometimes

Does a hearing problem cause you difficulty when visiting friends, relatives or neighbors?

Yes
No
Sometimes

Does a hearing problem cause you to attend meetings/religious services less often than you would like?

Yes
No
Sometimes

Does a hearing problem cause you to have arguments with family members?

Yes
No
Sometimes

Does a hearing problem cause you difficulty when listening to TV or radio?

Yes
No
Sometimes

Do you feel that any difficulty with your hearing limits or hampers your personal or social life?

Yes
No
Sometimes

Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?

Yes
No
Sometimes




Your Total Score Is: 0