Hearing Loss Facts
Hearing Services
Hearing Questionnaire About Yourself
About Hearing Loss
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Types & Causes
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Hearing Questionnaire
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Hearing Aid Benefits
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Hearing Loss in Children
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Links & Resources
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At Miracle-Ear, it is our mission to find the best personal solution for each individual’s communication needs. We will only be successful in reaching this goal if we take the time to compile the following information about you.

Please answer the following questions by checking the appropriate response.

Yes
Some
times
No
1. Does a hearing problem cause you to feel embarrassed when you meet new people?
2. Does a hearing problem cause you to feel frustrated when talking to members of your family?
3. Do you have difficulty hearing when someone speaks in a whisper?
4. Do you feel burdened by a hearing problem?
5. Does a hearing problem cause you difficulty when visiting friends, relatives or neighbors?
6. Does a hearing problem cause you to attend large group situations less often than you would like?
7. Does a hearing problem cause you to have arguments with family members?
8. Does a hearing problem cause you difficulty when listening to TV or radio?
9. Do you feel that any difficulty with your hearing limits or hampers your personal or social life?
10. Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?

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