Yes

Sometimes

No

1. Does difficulty with hearing cause you to feel embarressed when meeting new people?

2. Does a hearing problem cause you difficulty hearing/understanding co-workers, clients, or customers?

3. Do you feel frustrated when talking to members of your family due to your hearing capability?

4. Do you feel handicapped by a hearing problem?

5. Do you experience difficulty when visiting friends, relatives, or neighbors because of your hearing?

6. Do you have trouble hearing in the movies or theater?

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

8. When listening to a TV or radio, do you experience difficulty in hearing?

9. Do you feel that a problem with your hearing limits or hampers your personal or social life?

10. Does a difficult hearing situation cause you problems when in a restaurant with relatives or friends?