Hearing Assessment Survey

Please fill out this form and click submit.

Name

*

Email

*

This address will receive a confirmation email

Do you have some noticable hearing loss?

*

Please select one option.

Yes No

Are you having difficulty hearing during Sunday Services?

*

Please select one option.

Yes No

If Yes, which settings are problematic? Select all that apply.

Please select all that apply.

Founders Hall during the sermon Founders Hall with portable mics Founders Hall during social events Amphitheater during sermons Amphitheater when portable mics are used Coffee hour in the core area None of the above

Are there other situations that are problematic?

Do you wear a hearing aid(s)?

*

Please select one option.

Yes No

If Yes, what is the brand (and model if known)?

Does your hearing problem lessen your activity at the Fellowship?

*

Please select one option.

Yes No

Are you able to help us test a broadcast solution some Sunday Service in the next few weeks? It would require you supply hearing aids, headphones, or ear buds.

*

Please select one option.

Yes No

Any other final comments? Do you have any suggestions that might help?

Thank you for your response to this form.

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