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Almost Always Half The time Occasionally Never Free Hearing Screening 5 Minute Hearing Survey 1.   I have a problem hearing over the phone. 2.   I have trouble following the conversation when two        or more people are talking at the same time. 3.   People complain that I turn the TV volume too high. 4.   I have to strain to understand conversations. 5.   I have trouble hearing conversations in a noisy       background such as a party. 6.   I miss hearing some common sounds like the phone       or doorbell ring. 7.   I get confused about where sounds come from. 8.   I misunderstand some words in a sentence and need       to ask people to repeat themselves. 9.   I especially have trouble understanding the speech       of women and children. 10. I have worked in noisy environments. 11. Many people mumble when they talk. 12. People get annoyed because I misunderstand what       is being said. 13. I misunderstand what others are saying and make       inappropriate responses. 14. I avoid social activities because I cannot hear well       and fear that I'll reply improperly. To be answered by a family member 15. Do you think this person has a hearing loss? 16. Do you have a blood relative with hearing loss?