Self Assessment
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Categories
- A - Hearing Damage 0%
- B - Stress 0%
- C - No Major Issues 0%
- D - Auditory Processing 0%
- E - Tinnitus 0%
- F - Emotional Issues 0%
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Question 1 of 28
1. Question
Do you worry a lot about the future?
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Question 2 of 28
2. Question
Have you had ringing or other noise in the ears for a long time?
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Question 3 of 28
3. Question
Do you use a hearing aid?
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Question 4 of 28
4. Question
Do you like language and communicate easily?
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Question 5 of 28
5. Question
Do you have trouble expressing yourself in words or following instructions?
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Question 6 of 28
6. Question
Do you often feel depressed or blue?
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Question 7 of 28
7. Question
Do your ears often feel blocked or make popping sounds?
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Question 8 of 28
8. Question
Are you sensitive to noise and have to stay away from it?
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Question 9 of 28
9. Question
Do you have difficulty spelling or pronouncing complicated words?
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Question 10 of 28
10. Question
Do you often feel angry or resentful?
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Question 11 of 28
11. Question
Do you have noise in the ears which causes you to feel anxious or depressed?
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Question 12 of 28
12. Question
Are you troubled by dizziness or vertigo or loss of balance?
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Question 13 of 28
13. Question
Has your life been significantly affected by a major loss?
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Question 14 of 28
14. Question
Do you have poor memory and concentration?
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Question 15 of 28
15. Question
Do you suffer from fatigue or lack of energy?
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Question 16 of 28
16. Question
Do you find you have problems learning new things?
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Question 17 of 28
17. Question
Do you often have to ask people to repeat themselves?
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Question 18 of 28
18. Question
Do you find yourself feeling stressed when you are in noisy environments?
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Question 19 of 28
19. Question
Did you have a lot of ear infections as a child?
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Question 20 of 28
20. Question
Are you troubled by tinnitus (noise in the ears-ringing, buzzing, hissing etc)?
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Question 21 of 28
21. Question
Do you have trouble following a conversation in a noisy room?
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Question 22 of 28
22. Question
Do you often have trouble sleeping?
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Question 23 of 28
23. Question
Do you sleep well and normally wake refreshed??
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Question 24 of 28
24. Question
Do you have trouble following the ideas when you read?
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Question 25 of 28
25. Question
Have you had ear or sinus infections which left you with ringing in the ears?
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Question 26 of 28
26. Question
Does your family complain that you are deaf?
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Question 27 of 28
27. Question
Do you often long for peace and quiet?
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Question 28 of 28
28. Question
Are you usually energetic and active?