Questionnaire Hearing and Listening difficulties screening

For each question, place a checkmark in the circle under the answer that best describes your listening and hearing experiences. Please only use one checkmark per question and answer all the questions.

This questionnaire was designed by Martin Fortin, MOA, audiologist, in conjunction with Lobe Santé auditive et communication. No part of this document can be reproduced without the written permission of Lobe Santé auditive et communication:
1 866 411-5623 • www.lobe.ca

6 points 4 points 2 points 0 point
 
1. I have trouble understanding the conversation when I speak with someone while in the presence of noise (eg. at the shopping centre, at the restaurant, or in the car).
2. I must turn up the volume of the television or the radio to better understand.
3. I have trouble understanding conversations when several persons are talking at the same time.
4. I have trouble hearing when someone knocks at the door.
5. I have trouble hearing the phone ring if I am in another room of the house.
6. I have trouble understanding if I don’t see the face of the person with whom I’m speaking.
7. I have trouble understanding if people talk too fast.
8. I have trouble understanding over the telephone.
9. I have trouble finding where sounds are coming from.
10. I have trouble understanding if someone speaks to me from another room.

In what age group are you?

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Your hearing is considered normal. Good for you for taking the time to fill out this questionnaire. It's a step in the right direction in caring for your hearing health. If you have any questions or concerns about your hearing, don't hesitate to speak to one of the professionals at our Lobe Santé auditive et communication multidisciplinary clinics today! To find the multidisciplinary clinic nearest you, click here or call us toll-​free by dialling 1 866 411-​5623. We will gladly direct you to the person best suited to answer your questions.

Your final score is between 20 and 24. To help prevent hearing loss, It is advisable that you fill out this questionnaire every year. However, if you sense that your hearing is not as sharp as it used to be and is keeping you from living your life to the fullest, don't hesitate to speak to one of the professionals at our Lobe Santé auditive et communication multidisciplinary clinics today! To find the multidisciplinary clinic nearest you, click here or call us toll-​free by dialling 1 866 411-​5623. We will gladly direct you to the person best suited to answer your questions.

Your final score is equal to or greater than 24. We recommend you have your hearing examined. Consult the professionals at our Lobe Santé auditive et communication multidisciplinary clinics today! To find the multidisciplinary clinic nearest you, click here or call us toll-​free by dialling 1 866 411-​5623. We will gladly direct you to the person best suited to answer your questions.

 
 

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