Please Take a Moment to Answer

These Tinnitus Screening Questions:

Name

First Name

Last Name

Is your ear ringing in one ear or both ears?

Is it high-pitched or low-pitched?

Do you have any hearing loss associated with the ringing?

Have you been assessed by an ENT and audiologist?

Were you ever in the military, or have you spent time at an indoor shooting range?

Can you recall any falls or injuries where your head/neck were jolted or injured? If som please describe it in detail below: