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Thank you for considering ENT Specialists, PC to help with your hearing needs. Please take a few minutes to complete this short questionnaire. Should we find that you have a hearing loss, your answers will help us understand your communication needs, your personal preferences, and your expectations.
Our goal is to improve your quality of life by finding solutions to meet your lifestyle.
Please complete the following questions. Be as honest as possible. Be as precise as possible.
Thank You. |
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| 1. Please list the top three situations where you would most like to hear better. Be as specific as possible: |
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| 5. What is your most important consideration regarding hearing aids? Rank order the following factors by selecting 1 as the most important and 4 as the least important. Leave as "No Selection" if it has no importance to you at all. |
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Hearing aid size and the ability of others not to see the hearing aids: |
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Improved ability to hear and understand speech: |
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Improved ability to understand speech in noisy situations (e.g., restaurants, parties): |
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Cost of the hearing aids: |
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6. Do you prefer hearing aids that: (Choose One) |
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