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	¨ ¨ ¨ ¨ ¨	¨ ¨ ¨ ¨ ¨	¨ ¨ ¨ ¨ ¨	¨ ¨ ¨ ¨ ¨	¨ ¨ ¨ ¨ ¨	¨ ¨ ¨ ¨ ¨	¨ ¨ ¨ ¨ ¨
List other situations not noted above
Comments/questions to raise with your audiologist or hearing aid dispenser