1 Minute Hearing Test - Kaw Valley Hearing

Name: Kaw Valley Hearing
Price range: $

Lawrence: 785-856-4200

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* Indicates required field

Name *

First

Last

Phone *

Email *

Which clinic location is most convenient for you? *

Do you find yourself having difficulty hearing in the presence of background noise? *

Yes No Maybe

Do you find yourself watching a persons lips closely to follow the conversation? *

Yes No Maybe

Do you feel that you have to strain to hear when someone talks or whispers? *

Yes No Maybe

Do you feel people mumble when they talk to you? *

Yes No Maybe

Do you ask people to repeat what was said? *

Yes No Maybe

Do you find yourself turning up the television? *

Yes No

Are loud sounds overly bothersome? *

All the time Sometimes Not often Never

Do you have difficulty understanding what children are saying? *

Yes No

Do you experience a ringing or buzzing sound in your ear(s)? *

Yes No Sometimes

When with a group of people, do you have difficulty following the conversation? *

Yes No

Submit

*Kaw Valley Hearing will be in contact with you within 24 hours (M-F) of submission of your questionairre to discuss the results.

(785) 856-4200 Phone
(785) 856-4204 Fax

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