{"id":6745,"date":"2020-02-27T14:08:36","date_gmt":"2020-02-27T22:08:33","guid":{"rendered":"https:\/\/entsalem.fm1.dev-11\/hearing\/hearing-loss\/hearing-loss-questionnaire\/"},"modified":"2020-07-10T12:38:53","modified_gmt":"2020-07-10T19:38:53","slug":"questionnaire","status":"publish","type":"page","link":"https:\/\/entsalem.com\/hearing\/hearing-loss\/questionnaire\/","title":{"rendered":"Hearing Loss Questionnaire"},"content":{"rendered":"\n<div id=\"hearing_quiz\" class=\"quiz hearing-quiz\">\r\n\r\n\t\t\t<div class=\"quiz-status\">\r\n\t\t\t\t<ul class=\"quiz-status-steps\">\r\n\t\t\t\t\t<li class=\"quiz-status-step quiz-step1 quiz-current\"><span class=\"quiz-status-circle fa fa-check\"><\/span><\/li>\r\n\t\t\t\t\t<li class=\"quiz-status-step quiz-step2\"><span class=\"quiz-status-circle fa fa-check\"><\/span><\/li>\r\n\t\t\t\t\t<li class=\"quiz-status-step quiz-step3\"><span class=\"quiz-status-circle fa fa-check\"><\/span><\/li>\r\n\t\t\t\t\t<li class=\"quiz-status-step quiz-step4\"><span class=\"quiz-status-circle fa fa-check\"><\/span><\/li>\r\n\t\t\t\t\t<li class=\"quiz-status-step quiz-step5\"><span class=\"quiz-status-circle fa fa-check\"><\/span><\/li>\r\n\t\t\t\t\t<li class=\"quiz-status-step quiz-step6\"><span class=\"quiz-status-circle fa fa-check\"><\/span><\/li>\r\n\t\t\t\t\t<li class=\"quiz-status-step quiz-step7\"><span class=\"quiz-status-circle fa fa-check\"><\/span><\/li>\r\n\t\t\t\t<\/ul>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"quiz-steps\">\r\n\r\n\t\t\t\t<div class=\"quiz-step quiz-step1 quiz-start-step quiz-current\" data-step=\"1\">\r\n\t\t\t\t\t<div class=\"quiz-step-content\">\r\n\t\t\t\t\t\tThink you may have hearing loss? Willamette ENT &amp; Facial Plastic Surgery is here to help. Start your journey toward better hearing by taking our quick and easy hearing quiz.\r\n\t\t\t\t\t\t<div class=\"quiz-start\"><button class=\"button quiz-start-button quiz-next_step\">Start My Hearing Quiz<\/button><\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div class=\"quiz-step quiz-step2 quiz-question\" data-step=\"2\">\r\n\t\t\t\t\t<div class=\"quiz-step-content\">\r\n\t\t\t\t\t\t<p>Do you frequently ask people to repeat themselves?<\/p>\r\n\t\t\t\t\t\t<div class=\"quiz-answers\">\r\n\t\t\t\t\t\t\t<label class=\"quiz-answer\"><input type=\"radio\" name=\"step2\" value=\"Yes\" class=\"quiz-answer-radio\" \/> <span class=\"button quiz-answer-text\">Yes<\/span><\/label>\r\n\t\t\t\t\t\t\t<label class=\"quiz-answer\"><input type=\"radio\" name=\"quiz-step2\" value=\"No\" class=\"quiz-answer-radio\" \/> <span class=\"button quiz-answer-text\">No<\/span><\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div class=\"quiz-step quiz-step3 quiz-question\" data-step=\"3\">\r\n\t\t\t\t\t<div class=\"quiz-step-content\">\r\n\t\t\t\t\t\t<p>Do you prefer to listen to the television or radio louder than others?<\/p>\r\n\t\t\t\t\t\t<div class=\"quiz-answers\">\r\n\t\t\t\t\t\t\t<label class=\"quiz-answer\"><input type=\"radio\" name=\"step3\" value=\"Yes\" class=\"quiz-answer-radio\" \/> <span class=\"button quiz-answer-text\">Yes<\/span><\/label>\r\n\t\t\t\t\t\t\t<label class=\"quiz-answer\"><input type=\"radio\" name=\"step3\" value=\"No\" class=\"quiz-answer-radio\" \/> <span class=\"button quiz-answer-text\">No<\/span><\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div class=\"quiz-step quiz-step4 quiz-question\" data-step=\"4\">\r\n\t\t\t\t\t<div class=\"quiz-step-content\">\r\n\t\t\t\t\t\t<p>Do you avoid group meetings, social occasions or family gatherings where listening may be difficult?<\/p>\r\n\t\t\t\t\t\t<div class=\"quiz-answers\">\r\n\t\t\t\t\t\t\t<label class=\"quiz-answer\"><input type=\"radio\" name=\"step4\" value=\"Yes\" class=\"quiz-answer-radio\" \/> <span class=\"button quiz-answer-text\">Yes<\/span><\/label>\r\n\t\t\t\t\t\t\t<label class=\"quiz-answer\"><input type=\"radio\" name=\"step4\" value=\"No\" class=\"quiz-answer-radio\" \/> <span class=\"button quiz-answer-text\">No<\/span><\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div class=\"quiz-step quiz-step5 quiz-question\" data-step=\"5\">\r\n\t\t\t\t\t<div class=\"quiz-step-content\">\r\n\t\t\t\t\t\t<p>Do people seem to mumble or speak in a softer voice than they used to?<\/p>\r\n\t\t\t\t\t\t<div class=\"quiz-answers\">\r\n\t\t\t\t\t\t\t<label class=\"quiz-answer\"><input type=\"radio\" name=\"step5\" value=\"Yes\" class=\"quiz-answer-radio\" \/> <span class=\"button quiz-answer-text\">Yes<\/span><\/label>\r\n\t\t\t\t\t\t\t<label class=\"quiz-answer\"><input type=\"radio\" name=\"step5\" value=\"No\" class=\"quiz-answer-radio\" \/> <span class=\"button quiz-answer-text\">No<\/span><\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div class=\"quiz-step quiz-step6 quiz-question\" data-step=\"6\">\r\n\t\t\t\t\t<div class=\"quiz-step-content\">\r\n\t\t\t\t\t\t<p>When you are in a group or crowded restaurant, is it difficult for you to follow the conversation?<\/p>\r\n\t\t\t\t\t\t<div class=\"quiz-answers\">\r\n\t\t\t\t\t\t\t<label class=\"quiz-answer\"><input type=\"radio\" name=\"step6\" value=\"Yes\" class=\"quiz-answer-radio\" \/> <span class=\"button quiz-answer-text\">Yes<\/span><\/label>\r\n\t\t\t\t\t\t\t<label class=\"quiz-answer\"><input type=\"radio\" name=\"step6\" value=\"No\" class=\"quiz-answer-radio\" \/> <span class=\"button quiz-answer-text\">No<\/span><\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div class=\"quiz-step quiz-step7 quiz-final-step\" data-step=\"7\">\r\n\t\t\t\t\t<div class=\"quiz-step-content\">\r\n\t\t\t\t\t\t\n<div class=\"quiz-answer-yes\">\n<h3>Your answers indicate that you may be experiencing hearing loss.<\/h3>\n<\/div>\n<div class=\"quiz-answer-no\">\n<h3>Your answers to the quiz indicate that your hearing loss may be minimal.<\/h3>\nAs with any medical condition, early intervention is key.\n<\/div>\n<div class=\"quiz-action\">Complete the form below to request an appointment or contact us at <a href=\"tel:+15035811567\" class=\"phone \"> <span class=\"phNum\">(503) 581-1567<\/span><\/a>.<\/div>\n<div class=\"quiz-contact-form\"><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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class=\"quiz-privacy-policy\">We will use your information to respond to you, regarding the reason you contacted us. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request. View our <a href=\"\" target=\"_blank\" rel=\"noopener noreferrer\">Privacy Policy<\/a>.<\/div>\n<\/div>\n\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div class=\"quiz-step quiz-step8 quiz-thank-step\" data-step=\"8\">\r\n\t\t\t\t\t<div class=\"quiz-step-content\">\r\n\t\t\t\t\t\t<h3>Thank You!<\/h3>\r\n\t\t\t\t\t\tThank you for completing our online hearing quiz. We will be in contact with you shortly to setup your hearing consultation appointment.\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<p class=\"quiz-legal\">An online hearing quiz is not a substitute for a hearing evaluation performed by a licensed audiologist. For an accurate diagnosis, visit a local hearing care professional to receive an extensive exam.<\/p>\r\n\r\n\t\t<\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":173,"menu_order":7,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"(503) 581-1567 | Take this questionnaire to identify hearing loss signs you may be experiencing. An audiologist can provide a complete diagnosis. 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