Hearing Loss Screening Questionnaire (Self / Proxy)
Choose a score from 0 to 5 for each question. 0 = No problem, 5 = Severe problem.
Instructions:
- 0 = No problem
- 1 = Very slight problem
- 2 = Mild problem
- 3 = Moderate problem
- 4 = Significant problem
- 5 = Severe problem
