Hearing Assessment

Take the Hearing Assessment (H.H.I.E-S)

We will not share your name or email address...

Once you have submitted the following form one of our Hearing Specialists will contact you with your results.

Your Name (required)

Your Email (required)

Your Phone (required)

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

 Yes Sometimes No

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

 Yes Sometimes No

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

 Yes Sometimes No

Do you feel handicapped by a hearing problem?

 Yes Sometimes No

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

 Yes Sometimes No

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

 Yes Sometimes No

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

 Yes Sometimes No

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

 Yes Sometimes No

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

 Yes Sometimes No

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

 Yes Sometimes No

Copy the following into the space below:

captcha