| 1. | Do you experience ringing or noises in your ears? | YES NO |
| 2. | Do you hear better with one ear than the other? | YES NO |
| 3. | Have any of your relatives had a hearing loss? | YES NO |
| 4. | Have you had significant noise exposure at work, recreation or in military service? | YES NO |
| 5. | Do you find it difficult to follow a conversation in a noisy restaurant or crowded room? | YES NO |
| 6. | Do you sometimes feel people are mumbling or not speaking clearly? | YES NO |
| 7. | Do you experience difficulty following dialog in theatre? | YES NO |
| 8. | Do you sometimes find it difficult to understand a speaker at a public meeting or religious service? | YES NO |
| 9. | Do you sometimes find yourself asking people to speak up or to repeat themselves? | YES NO |
| 10. | Do you find men's voices easier to understand than women's? | YES NO |
| 11. | Do you experience difficulty understanding soft or whispered speech? | YES NO |
| 12. | Do you sometimes have difficulty understanding speech or words on the telephone? | YES NO |
| 13. | Does a hearing problem cause you to feel embarrassed when meeting new people? | YES NO |
| 14. | Does a hearing problem cause you to be nervous? | YES NO |
| 15. | Does a hearing problem cause you to visit friends, relatives or neighbors less often then you like? | YES NO |
| 16. | Does a hearing problem cause you to talk to family members less often then you would like? | YES NO |
| 17. | Does a hearing problem cause you to feel depressed? | YES NO |
| 18. | Do you feel handicapped by a hearing problem? | YES NO |
If you answered YES to any of these questions it may mean that you have a hearing problem. If you answered YES to more than a few questions,
then we strongly suggest a hearing evaluation in your near future is necessary.
To make an appointment with us now, call (780) 423-2116 or toll free outside of Edmonton 1-877-423-2116.