Hearing Test Registration Form - Better Hearing Canada

Hello

We will gather some of your information and ask some questions for your report. When you press "Start the Test" you will switch to our A.I. Hearing Test App. At the end of the hearing test you will have a report you can print out and bring to your Audiologist for a proper examination should you feel one is needed..

Lets Begin

Hearing Test Registration Form

First Name

Last Name

Your Age

Your Gender

Email

Phone no.

How would you describe your hearing

Poor

Good

Not Sure

Do you find it hard to follow one on one conversations with people

Always

Often

Sometimes

Rarely

Never

Do you Find it hard to follow conversations in noisy environments such as a crowded restaurants

Always

Often

Sometimes

Rarely

Never

Are you Human?

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