Does a close friend or family member have hearing loss?

Has your loved one ever complained about hearing problems?

Yes No

Have you noticed your friend or relative struggling to understand you in a face-to-face conversation?

Yes No

Does he/she ask you to speak louder or more clearly on a consistent basis?

Yes No

Have you felt that a possible hearing problem has caused him/her to have arguments with you or other friends and family?

Yes No

Does your loved one turn up the television or radio louder than others?

Yes No

Have you noticed him/her attending less social events due to a possible hearing loss?

Yes No

Does he/she consistently avoid social situations?

Yes No

Does he/she complain about a continuous or repeated ringing in their ears?

Yes No