The National Hearing Test - Hearing Screening by Phone

1. Please provide your email address to receive your access code by email.

Note: A valid email address is required to receive your test access code by email.

2. Have you had regular exposure to intense noise? Examples include factory noise,
heavy machinery, loud equipment, and gunfire.

***Please Select***YESSOMEWHATNO

3. Have you had frequent exposure to loud music?

***Please Select***YESSOMEWHATNO

4. What is your age?

5. What is your sex?

6. Please indicate your race/ethnicity. Check ALL that apply:

7. How did you learn of the National Hearing Test? Check ALL that apply:

********** If you have a discount coupon code, please enter it here. **********

Please click on the Submit button to submit your answers and go to the payment page.