{"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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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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