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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