Hearing Questionnaire Please take your time to answer the questions below, perhaps together with a close friend or family member who might have commented on your hearing ability.Name* First Last Email* Date of Birth DD MM YYYY QuestionsWhen watching television with others, do you need to set the volume higher than they would like to hear what is being said?YesNoDo you often need to ask people to repeat what they have said?*YesNoDo you often feel that other people are 'mumbling' or speaking unclearly?*YesNoDo you often have trouble understanding a conversation when there is background noise or other people are talking at the same time?*YesNoHave your family members / colleagues / friends asked you whether you have a hearing problem?*YesNoDo you avoid parties and social events because there is too much noise or you can't hear what people are saying?*YesNoDuring conversations in a car, a restaurant or another noisy place, do you often misunderstand what is being said?*YesNoDo you feel stressed or tired when you have had to talk or listen for long periods?*YesNoDo you need to sit close to the speakers at meetings, religious services, or at the dinner table in order to understand?*YesNoDo you often experience problems hearing and understanding what other people are saying to you when you do not have eye contact?*YesNoDo you often find it hard to localize the source of sounds?*YesNoCommentsThis field is for validation purposes and should be left unchanged.