Tinnitus Questionnaire

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

A survey to determine how tinnitus affects daily life.
Thank you for agreeing to take part in this survey. Your responses will be used to ascertain an understanding of how your tinnitus affects you, what you believe to be the cause of your tinnitus, and how you relieve your tinnitus. All of your responses are completely anonymous and will be held in the strictest confidence and only used for the purposes of research. Thank you for your engagement.
Sign in to Google to save your progress. Learn more
What gender do you identify as? *
What age are you? *
How long have you suffered from tinnitus? *
Do you know your tinnitus tone frequency? *
Where do you perceive your tinnitus? *
What do you believe to be the cause of your tinnitus? *
On a scale of 1 - 10, with 10 being extremely and 1 being hardly at all, how debilitating would you say your tinnitus is? *
How often does your tinnitus severely affect you? *
Do you use tinnitus therapy methods? If yes, please choose which ones from the answers below. *
If you do not use tinnitus therapy methods, please can you briefly explain why?
Your answer
If you do not use tinnitus therapy methods, such as those listed above, how likely are you to use them in future? With 1 being very likely and 5 being not likely at all.
Clear selection
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy