Diary

 

Key issues
Day 1 ________
Day 2 ________
Day 3 ________
Day 4 ________
Day 5 ________
Day 6 ________
Day 7 _______
How many hours did you wear your aids for today?
 
 
_____ hrs
 
_____ hrs
 
_____ hrs
 
_____ hrs
 
_____ hrs
 
_____ hrs
 
_____ hrs
Could you insert them without difficulty?
 
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Could you take them out without any problems?
 
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Did you experience any soreness or discomfort while wearing the hearing aids?
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Did you have any problems using the controls?
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
Yes ¨
No ¨
In which situations did you wear the aids today?
 
Watching TV
 
Using telephone
 
face-to-face conversation in quiet
 
face-to-face conversation in noise
 
Group conversation
 
 
 
 
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List other situations not noted above
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Comments/questions to raise with your audiologist or hearing aid dispenser