Subjective Hearing Aid Performance Questionnaire

Help us prepare for your visit, and save time at your appointment by completing this questionnaire online. Your responses will help us assess the effectiveness of your hearing aids and guide us to make adjustments that will improve your hearing.

Please answer all questions below.

None Less than 1 hour a day 1 to 4 hours a day 4 to 8 hours a day more than 8 hours a day

Helped not at all Helped slightly Helped moderately Helped quite a lot Helped very much

Very much difficulty Quite a lot of difficulty Moderate difficulty Slight difficulty No difficulty

Not at all worth it Slightly worth it Moderately worth it Quite a lot worth it Very much worth it

Affected very much Affected quite a lot Affected moderately Affected slightly Affected not at all

Bothered very much Bothered quite a lot Bothered moderately Bothered slightly Bothered not at all

Worse No change Slightly better Quite a lot better Very much better

Severe Moderately-severe Moderate Mild None

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Dr. Ana Anzola Dr. Wendy Thorne Dr. Linda Himler Dr. Travis Stehouwer Christine Cubelo Don't Know

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