Your Personalized Plan - Sage Audiology

What brought you here today? *

Do you have hearing loss? *

Do you now, or have you ever, worn hearing aids? *

Which of the following statements are true about you? (check all that apply) *

Over the last week, I couldn't understand what overs were saying in noisy or crowded places.
Over the last week, I couldn't understand what people were saying on TV or in movies.
Over the last week, I couldn't understand people with soft voices.
Over the last week, I couldn't understand what was being said in group conversations.
Over the last week, I heard and communicated clearly with everyone around me.

Do you have tinnitus? *

Which of the following statements true about you? (check all that apply) *

Over the last week, have you noticed sensitivity to everyday sounds? *

Which of the below services would you like to learn more about, if any? *

How would you prefer we connect? *

Name *

First

Last

Phone *

Email *

Anything else to add?