| 1. |
Does a hearing problem cause you to feel embrrassed
when meeting new people? |
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| 2. |
Does a hearing problem cause you to feel frustrated
when talking to members of your family? |
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| 3. |
Do you have difficulty hearing when someone speak in a
whisper? |
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| 4. |
Do you feel handicapped by a hearing problem? |
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| 5. |
Does a hearing problem cause you difficulty when
visiting friends, relative or neighbors? |
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| 6. |
Does a hearing problem cause you to attend religious
services less often then you would like? |
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| 7. |
Does a hearing problem cause you to have arguments
with family members? |
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| 8. |
Does a hearing problem cause you difficulty when
listening to television or radio? |
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| 9. |
Do you feel that any difficulty with your hearing
limits or hampers your personal or social life? |
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| 10. |
Does a hearing problem cause you
difficulty when in a restaurant with relatives or friends? |
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