Hearing loss survey

If you are affected by hearing loss, we would like to hear from you. The information provided will help us decide what research we should carry out in the coming years.

Please fill in the form below and click on send form.

If you know someone affected by hearing loss, please let them know about our survey so they can complete it too. It is important to us to get as many views as possible. To email this page to them, click on the 'Email this page to a friend' link in the left column.

Please do not enter data in this field, it is meant to stop spambots, who fill out any field

1	Are you male or female?  male     female
2	What is your age?  18-34    35-49    50-64    65+
3	Which city or town do you live in/near?
4	Is your hearing loss in one ear or both?  one ear    both ears
5	Which statement best describes you? I wear a hearing aid in one ear I wear a hearing aid in both ears I don't wear a hearing aid
Only answer questions 6-16 if you wear a hearing aid
6	Are you currently wearing an NHS or private hearing aid? NHS private A mix of NHS and private
7	What type of hearing aid do you currently wear? analogue     digital
8	If digital, have you previously worn an analogue hearing aid? yes     no
9	Please answer if you have experience of wearing both an analogue and a digital hearing aid. Otherwise please go to question 10.
	Compared to my old analogue hearing aid(s), my digital aid(s) are:   a lot better       a little better       about the same       a little worse       a lot worse       I don't know
	Compared to my old analogue hearing aid(s), I can hear in crowded situations:   a lot better       a little better       about the same       a little worse       a lot worse       I don't know
	Compared to my old analogue hearing aid(s), I can understand what people are saying to me:   a lot better       a little better       about the same       a little worse       a lot worse       I don't know
10	Please answer if you have a hearing loss in both ears. If you have a hearing loss in only one ear please go to question 15.
	Thinking about the last time you were fitted with a hearing aid, which statement best describes what happened? I was given one hearing aid - I only wear one hearing aid. (please go to question 13) I was given one hearing aid - in addition to an existing aid, so now I wear an aid in both ears. (please go to question 11) I was given two hearing aids. (please go to question 11)
11	If you wear two hearing aids, how does it compare to wearing one?   a lot better       a little better       about the same       a little worse       a lot worse       I don't know, I've only ever worn two
12	If you wear two hearing aids, for how long have you worn two aids?   1-12 months       13-24 months       25-36 months       more than three years
13	If you have a hearing loss in both ears, have you at any time been turned down by the NHS to receive a second hearing aid? yes (please go to question 14) no (please go to question 15) I go private (please go to question 15)
14	If you were turned down to receive a second NHS aid, was this...?   in the last three years       three years ago or longer
15	If you have one or more digital hearing aids, how satisfied are you with it/them?   very satisfied       fairly satisfied       neither satisfied nor unsatisfied       fairly unsatisfied       very unsatisfied
16	In what situations do you find your digital hearing aid(s) most helpful, if any?
	Any other comments?
	Would you be interested in sharing your experiences of hearing loss? If yes, please fill in the details below:
	Name
	Address
	Phone
	Email
	How would you like to be contacted? by post    by telephone     by email
	Deafness Research UK is committed to providing information about deafness, tinnitus and other hearing problems. If you do not wish to receive further communications from us please tick here:
	Thank you for taking the time to fill in this questionnaire. Click on the 'Send form' button to send it to us.