Does your hearing problem cause...
        ___ embarrassment meeting new people?
        ___ frustration talking to family, friends?
        ___ difficulty listening to a whisper?
        ___ you to feel handicapped?
        ___ you to feel left out of conversations?
        ___ difficulty hearing on the phone?
        ___ difficulty hearing TV?
        ___ limitations to your social life?
        ___ arguments with your family?
        ___ difficulty hearing in restaurants?
        ___ TOTAL SCORE
             * A score of 6 or more indicates that you should consider a complete hearing evaluation.