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Hearing screening questionnaire

Two minutes to answer the questionnaire

This hearing screening questionnaire will only take two minutes of your time. It assesses whether you need a comprehensive hearing test done by an audiologist.

Obtain your results by answering the questionnaire

Step 1 of 16

  • YesSometimesNo
* Required field.

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».