Hearing Aids Fitted by Carlson's California Licensed Hearing Instrument Specialist

Carlson's Hearing Aid Center • 128 Hartnell Avenue • Redding, CA 96002 • Tel: (530) 223 4567 • Fax: (530) 223 4566

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Hearing Self-Check

Do you think you have a hearing loss?
Would you like to know how to take that first step towards correction?
Answer the following questions below to submit request for your results.

Please check one answer for each question.
1. I have difficulty hearing in a group of people.		Always Almost Always Sometimes Almost Never Never

2. I hear people speak, but have difficulty understanding the words.		Always Almost Always Sometimes Almost Never Never

3. I have difficulty hearing on the telephone.		Always Almost Always Sometimes Almost Never Never

4. I set the volume on the television louder than others would like.		Always Almost Always Sometimes Almost Never Never

5. I have trouble hearing in church, at the movies and in other public places.		Always Almost Always Sometimes Almost Never Never

6. I have difficulty hearing children speak.		Always Almost Always Sometimes Almost Never Never

7. I can not hear a digital watch or alarm clockl beep.		Always Almost Always Sometimes Almost Never Never

8. I have to ask friends and family to repeat what they say.		Always Almost Always Sometimes Almost Never Never

9. I have trouble following a conversation with 2 or more people involved.		Always Almost Always Sometimes Almost Never Never

10. I find it hard to determine the direction from where the sound is coming from.		Always Almost Always Sometimes Almost Never Never

11. I find myself avoiding social events.		Always Almost Always Sometimes Almost Never Never

12. I get complaints that I misunderstand what people say to me.		Always Almost Always Sometimes Almost Never Never

13. I find myself asking people to speak more clearly.		Always Almost Always Sometimes Almost Never Never

14. I have worked in places where there were loud noises airports, heavy equipment.		Always Almost Always Sometimes Almost Never Never

15. I reply to people inappropriately because I misunderstand what they say.		Always Almost Always Sometimes Almost Never Never

16. I have a hearing aid		Yes No

17. I have had this hearing aid for		Less than a year 1 to 5 years More than 5 years
Please click here to personalize your test!

Self Test

To complete your test, please fill out required information. Results will be mailed.

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Please Note: The use of this information is not used for any other purpose other than the sole purpose of determining your score and providing you the results. We uphold your privacy in your best interest as if our own.