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Personal Assessment of Communication Abilities

Name(Required)
Date(Required)

How much difficulty do you have hearing for the following situations?

One-to-one conversation(Required)
Conversation in small groups(Required)
Conversation in large groups(Required)
Outdoors(Required)
Concert/Movie(Required)
Place of Worship/Lectures(Required)
Watching TV(Required)
In a Car(Required)
Workplace(Required)
Telephone – Landline(Required)
Telephone – Mobile(Required)
Restaurant/Cafe(Required)
Other(Required)