Significant other assessment of communication

Please select an answer for each question. If he/she wears a hearing aid, answer according to how they do without the hearing aid.

Does he/she experience communication difficulties in situations when speaking with one other person? (for example, at home, at work, in a social situation, with a waitress, a store clerk, with a spouse, boss, etc.)
Does he/she experience communication difficulties in situations when conversing with a small group of several people? (for example, with friends or family, co-workers, in meetings or casual conversations, over dinner or while playing cards, etc.)
Does he/she experience communication difficulties while listening to someone speak to a large group? (for example, at a church or civic meeting, in a fraternal or women's club, at an educational lecture, etc.)
Does he/she experience communication difficulties while participating in various types of entertainment? (for example, movies, TV, radio, plays, night clubs, musical entertainment, etc.)
Does he/she experience communication difficulties when you are in an unfavorable listening environment? (for example, at a noisy party, where there is background music, when riding in an auto or bus, when someone whispers or talks from across the room, etc.)
Does he/she experience communication difficulties when using or listening to various communication devices? (for example, telephone ring, doorbell, public address system, warning signals, alarms, etc.)
Does he/she feel that any difficulty with your hearing limits or hampers his/her personal or social life?
Does any problem or difficulty with his/her hearing upset them?
Do others suggest that he/she has a hearing problem?
Do others leave him/her out of conversations or become annoyed because of his/her hearing?