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H.E.A.R. Survey





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Thank you for helping us with our research. The following information is for H.E.A.R.'s research use only, we respect your privacy. If you are under 18 please ask your parent or guardian to email us their consent to take this test. Please answer these questions to the best of your ability.Thanks!

1. Do your ears ring after a concert? Yes No
2. Have you ever had trouble hearing conversation after a concert? Yes No
3. Has anyone ever told you that you might have a hearing loss? Yes No
4. What would you do in an overly loud situation?
5. Would you consider wearing hearing protection? Yes No
6. Are you a musician, dj or, someone who works in the music business? Yes No
If yes, how long have you been a musician or working in the music business field?
State occupation:
7. Do you play acoustic or amplified music? Acoustic
Amplified
Both
8. What instrument do you play? (example: guitar, turntables,rap/vocals)
9. When did you first notice that you might have tinnitus (ringing ears) or a hearing loss? Please specify
10. Have you ever had your ears examined by an ear doctor or your hearing checked by an audiologist? Yes No
11. Do you wear hearing protection while performing music? Yes No
If not, why not?
12. Did your hearing loss ever make it difficult for you to work? Yes No
13. Did your hearing loss ever cause you to lose or quit your job? Yes No
14. Did your tinnitus ever make it difficult for you to work? Yes No
15. Did your tinnitus ever cause you to lose or quit your work? Yes No
Name:
EMail:
Age:
Gender:
State:
Country:
   
What band or DJ group are you in?
 




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