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Hearing Loss Facts

Hearing questionnaire about your loved ones

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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 from those closest to your companion...you!

Please answer the following questions by checking the appropriate response.

Yes
Some
times
No
1. Have you observed a situation where a hearing problem caused him/her to feel embarrassed when meeting new people?
2. Do you feel a hearing problem causes him/her to feel frustrated when talking to members of his/her family?
3. Have you noticed that he/she has difficulty hearing when someone speaks in a whisper?
4. Do you believe he/she is burdened by a hearing problem?
5. Are you concerned that a hearing problem causes him/her difficulty when visiting friends, relatives or neighbors?
6. Do you think that a hearing problem causes him/her to attend large group situations less often than they would like?
7. Have you ever felt that a hearing problem causes him/her to have arguments with family members?
8. Have you noticed that a hearing problem causes him/her difficulty when listening to TV or radio?
9. Are you concerned that any difficulty with his/her hearing limits or hampers their personal or social life?
10. Have you observed that a hearing problem causes him/her difficulty when in a restaurant with relatives or friends?




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