Do I have an hearing loss?

If you answer YES to 2 or more questions, it is possible you are suffering from a hearing loss. Please fill in this simple questionnaire below, if you wound like Coastal hearing Services to arrange a hearing test.. Or contact your G.P.

Yes
	Do other people complain that you have the TV or radio to loud?
	Do you have difficulty holding a conversation when more than one person is talking or when there is background noise?
	Do you have difficulty holding a conversation on the telephone?
	Do you have difficulty hearing increased distances- i.e. at the theatre or church?
	Does your hearing seem "out of balance" -i.e. louder on one side than the other?
	Are you or have you ever been subjected to high levels of industrial noise or noisy hobbies like shooting or attending loud concerts?
	Have you ever injured either of your eardrums?
	Have you ever suffered from an infection or virus affecting the inner ear causing dizziness or tinnitus?

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