Hearing Test

1370 Gateway Blvd.
Suite 120
Murfreesboro, TN 37129
615.848.9265 ext. 120

1370 Gateway Blvd.
Suite 100
Murfreesboro, TN 37129
615.848.9265 ext. 126

300 StoneCrest Blvd.
Suite 375
Smyrna, TN 37167
615.223.9913 ext. 126

		Almost Always	Half the time	Occasionally	Never

1.	I have a problem hearing over the phone.
2.	I have trouble following the conversation when two or more people are talking at the same time.
3.	People complain that I turn the TV volume too high.
4.	I have to strain to understand conversations.
5.	I have trouble hearing conversations in a noisy background such as a party.
6.	I miss hearing some common sounds like the phone or doorbell ring.
7.	I get confused about where sounds come from.
8.	I misunderstand some words in a sentence and need to ask people to repeat themselves.
9.	I especially have trouble understanding the speech of women and children.
10.	I have worked in noisy environments.
11.	Many people mumble when they talk.
12.	People get annoyed because I misunderstand what is being said.
13.	I misunderstand what others are saying and make inappropriate responses.
14.	I avoid social activities because I cannot hear well and fear that I'll reply improperly.

To be answered by a family member
		YES	NO
15.	Do you think this person has a hearing loss?
16.	Do you have a blood relative with hearing loss?

Helping You Hear Better
because your
Hearing Matters