Prevention of Hearing Loss Screener

The next few slides will assess the current situation you are experiencing to enable us to recommend the best solution for you. We do request some personal information from you in order for us to suggest age-appropriate solutions as well as for an audiologist to be in touch with you.

As we subscribe to the POPIA, we commit to only using your personal information for the purposes mentioned above.

Click the arrow below right to begin the screener

Please complete as many fields as possible so we can give you the best advice.

First Name *

Last Name

Date of birth

Phone *

Email *

The following 13 questions will give us an indication of your current hearing environment. If you are completing this on behalf of someone else (eg. a child), please insert answers appropriate to them.

Do you have a history of ear aches or ear infections as an adult (18yrs or older)?

Yes

Do you have a direct family member (mother, father, sister or brother) with hearing loss?

Yes

Are you or do you have any of the following (check all that apply):

Overweight

Diabetic or pre-diabetic

Chronic autoimmune condition

Have you ever had "noise" in your ears? (eg. ringing in the ears)

Yes

Have you ever had a head injury or been unconscious?

Yes

Have you had any unexpected problems with balance?

Yes

Have you ever had ear surgery?

Yes

Have you ever had any of the following medications: mycins, quinine, or excessive aspirin?

Yes

Don't know

Please indicate any prescription and non-prescription medications that you are currently taking

Thank you for completing the previous questions. In order to suggest the closest, qualified iCAN audiologist to you, please select your province and insert the city/town and suburb in which you live.

Province in which you reside

City/Town

Suburb

This screener is now complete. Please click the submit button and an audiologist will be in touch.