Take Our Online
Hearing Test

Your Name*

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Phone

Date of Birth

Street Address

City

Post Code

Do you sometimes have difficulty understanding speech on the TV?
YesNo

Do you sometimes feel that music on the TV is lot louder than the Dialogue?
YesNo

Do you sometimes feel that people are mumbling and need to speak clearly?
YesNo

Do you find yourself asking people to speak up or repeat themselves?
YesNo

Do you experience difficulty understanding speech when a person walks away from you?
YesNo

Do you experience difficulty understanding grandchildren?
YesNo

Do you find it difficult to follow a conversation in a crowded room?
YesNo

Do you have ringing or hissing noise in your ears or head?
YesNo

Do you think your memory is not as good as it used to be?
YesNo

Did you have any hearing/ screening test in the past?
YesNo

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