Groupe Forget - Polyclinique de l'Oreille

HEARING SCREENING QUESTIONNAIRE

Answer this hearing screening questionnaire will take only a few minutes and you will be able to find out if you need to have a complete hearing evaluation by an audiologist.

Obtain your results by answering the questionnaire

Step 1 of 16

0%
  • YesSometimesNo
* All questions are required.

How the results of this hearing screening questionnaire are calculated?

For questions 1 to 14 inclusively:

  • Every “yes” is worth 4 points,
  • each “sometimes” is worth 2 points and
  • each “no” is worth 0 point.

For question 15:

  • Each “a” is worth 0 point,
  • “b” 2 points,
  • “c” 3 points and
  • “d” 4 points.

Your total

If the total is greater than 14, ask for a consultation with an audiologist, or with a healthcare professional for a referral in audiology.

Learn more about the hearing aid accessibility program and its modalities, or find the name of a physician, an E.N.T. specialist, an audiologist or an audioprosthetist in your neighbourhood, call now at 1-888-ENTENDRE or make an appointment.

How was this hearing screening questionnaire conceived?

Reproduction needs special authorization from author, Hélène Caron, M.O.A. audiologist.
Questionnaire realized by Hélène Caron, M.O.A., audiologist, Institut Raymond-Dewar, Scientific validation by Michel Picard, Ph.D., full professor of audiology, University of Montreal. Translated by Annie Noël, audiologist, with the collaboration of Dale Bonnycastle and Lilianne Brunetti, audiologists at the MacKay Rehabilitation Centre. Published in collaboration with the «Fondation Surdité et Communication of Institut Raymond-Dewar».