Who are you seeking information for? *

For Myself

For A Loved One

About How long have you noticed your tinnitus? *

Less than 1 year

1-3 Years

4-10 Years

10+ Years

If inquiring on behalf of someone else, answer based on that person's circumstances.

How did your tinnitus first appear? *

Sudden

Gradual

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What is the typical duration of your tinnitus when it occurs? *

A few minutes

Hours

Days

Constant

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Where does your tinnitus seem to be located? *

Right ear

Left ear

Both ears

Inside the head

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What areas of your life are affected by your tinnitus? *

Sleeping

Concentration

Work

Social life

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What does your tinnitus sound like? *If inquiring on behalf of someone else, answer based on that person's circumstances.

If Other, what does your tinnitus sound like? *

If inquiring on behalf of someone else, answer based on that person's circumstances.

Do you feel anxious, depressed, or overwhelmed by the tinnitus? *

Yes

Sometimes

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Have you had any thoughts of harming yourself or suicidal ideation related to tinnitus? *

Yes

Prefer not to say

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Your story matters - share any thoughts, experiences, or background on tinnitus here.

First Name *

Last Name *

Phone *

Email *

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