Hearing Questionaire Hearing Questionaire Using the chart above as reference, please score your answers to the following questions from 1 to 10. The questions should be answered as if you are not wearing hearing aids. Describe the level of the sounds of running water from the faucet.*1 : Comfortable2 : Comfortable3 : Comfortable4 : Soft5 : Soft6 : Muffled7 : Muffled8 : Muffled9 : Distant. . .Hard to Hear10 : Distant. . .Hard to HearIf a dog was barking next to you, please describe how it sounds.*1 : Comfortable. . .about as expected2 : Comfortable. . .about as expected3 : Comfortable. . .about as expected4 : Soft5 : Soft6 : Muffled7 : Muffled8 : Muffled9 : Distant. . .Hard to Hear10: Distant. . .Hard to HearDon't KnowIf a lawn mower was running next to you, please describe how it sounds.*1 : Loud. . .about as expected2 : Loud. . .about as expected3 : Loud. . .about as expected4 : Soft5 : Soft6 : Muffled7 : Muffled8 : Muffled9 : Distant. . .Hard to Hear10: Distant. . .Hard to HearDon't KnowDescribe the sound of a baby crying.*1 : Comfortable. . .about as expected2 : Comfortable. . .about as expected3 : Comfortable. . .about as expected4 : Soft5 : Soft6 : Muffled7 : Muffled8 : Muffled9 : Distant. . .Hard to Hear10: Distant. . .Hard to HearDon't KnowDescribe the level of sound of a piano playing.*1 : Comfortable2 : Comfortable3 : Comfortable4 : Soft5 : Soft6 : Muffled7 : Muffled8 : Muffled9 : Distant. . .Hard to Hear10: Distant. . .Hard to HearDon't KnowDescribe your ability to understand in a group conversation.*1 : Good Understanding2 : Good Understanding3 : Good Understanding4 : Some Difficulty5 : Some Difficulty6 : Very Difficult7 : Very Difficult8 : Very Difficult9 : Poor Understanding10: Poor UnderstandingDon't KnowDescribe the level of the sound of a clock ticking or a bird chirping.*1 : Comfortable2 : Comfortable3 : Comfortable4 : Soft5 : Soft6 : Muffled7 : Muffled8 : Muffled9 : Distant. . .Hard to Hear10: Distant. . .Hard to HearDon't KnowDescribe the level of the sound of a vacuum cleaner.*1 : Comfortable2 : Comfortable3 : Comfortable4 : Soft5 : Soft6 : Muffled7 : Muffled8 : Muffled9 : Distant. . .Hard to Hear10: Distant. . .Hard to HearDon't KnowDescribe the level of the sound of a phone rining.*1 : Comfortable2 : Comfortable3 : Comfortable4 : Soft5 : Soft6 : Muffled7 : Muffled8 : Muffled9 : Distant. . .Hard to Hear10: Distant. . .Hard to HearDon't KnowFirst Name*Last Name*Email Address*