Hearing Health Survey - Rochester Hearing & Speech Center Question Title * 1. How important is your hearing health relative to other areas of your health like vision and dental care? Extremely important Very important Somewhat important Not so important Not at all important Question Title * 2. Have friends or family ever suggested that you get your hearing tested? Yes No Question Title * 3. Have you had a hearing test in the last five years? Yes No Question Title * 4. If you've had a hearing test, please indicate where: With my Primary Care Physician. I had my hearing tested at a free community screening event I had my hearing tested at Rochester Hearing & Speech Center. I had my hearing tested with another hearing health provider. Question Title * 5. Were you diagnosed with hearing loss? Yes No Question Title * 6. Do you use a hearing instrument? Yes No Question Title * 7. What type of insurance do you have? Private insurance Medicaid/Medicare No insurance Question Title * 8. Do you experience any of the following challenges securing hearing health care? (Select all that apply.) I am not able to find a hearing health provider that accepts Medicaid/Medicare. My work schedule makes it difficult to schedule medical appointments. I do not have transportation. My insurance does not cover/fully cover my hearing health needs and I cannot afford the cost of treatment or a listening device. None of the above Other (please specify) Question Title * 9. Please indicate your age: 18-24 25-34 35-44 45-54 55-64 65+ Question Title * 10. Please indicate your employment status: Full-time Part-time Seasonal Unemployed / Not in Workforce Retired Done