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Hearing loss questionnaire:
Unanswered Questions will be Highlighted in Red.
1. Select your age	Select Your Age Grater than 70 yrs. Less than 70 yrs.
2. Select your sex	Select Your Sex Male Female
3. Highest grade (education) attened	Select Your Grade Less than or equal to 12 Greater than 12
4. Have you ever had deafness or trouble hearing with one or both ears?	Select Your Option Yes No
5. Did you ever see a doctor about it?	Select Your Option Yes No
6. Without a hearing aid, can you usually hear and understand what a person says without seeing his or her face if that person whispers to you from across the room?	Select Your Option Yes No
7.Without a hearing aid, can you usually hear and understand what a person says without seeing his or her face if that person talks to you in a normal voice from across the room?	Select Your Option Yes No