Free Tinnitus Test Welcome to your Tinnitus Test The purpose of this questionnaire is to identify, quantify, and evaluate the difficulties that you may be experiencing because of tinnitus. Please do not skip any questions. When you have answered all the questions, you will be presented with a score to represent the state of your Tinnitus. This will help you know where to start with treatment. 0: No Handicap 1-6: Mild Handicap (Grade 2) 7-14: Moderate Handicap (Grade 3) 15-20: Severe Handicap (Grade 4) Answer the following questions to the best of your abilities. If you have any questions, please contact us, and we can help. Navigate between questions with the 'Previous' and 'Next' buttons. Click the 'Next' button to get started. 1. Because of your tinnitus, is it difficult for you to concentrate? Yes Sometimes No 2. Because of your tinnitus, do you have trouble falling to sleep at night? Yes Sometimes No 3. Does your tinnitus interfere with your ability to enjoy your social activities (such as going out to dinner, to the movies)? Yes Sometimes No 4. Because of your tinnitus, is it difficult for you to read? Yes Sometimes No 5. Do you find it difficult to focus your attention away from your tinnitus and on other things? Yes Sometimes No 6. Does your tinnitus make you feel anxious? Yes Sometimes No 7. Does your tinnitus get worse when you are under stress? Yes Sometimes No 8. Because of your tinnitus, do you find that you are often irritable? Yes Sometimes No 9. Does your tinnitus interfere with your ability to enjoy your social activities (such as going out to dinner, to the movies)? Yes Sometimes No 10. Does the loudness of your tinnitus make it difficult for you to hear people? Yes Sometimes No 11 out of 10 Name Email Time is Up! Time's up
