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Pre-Test Survey

Before you take the National Hearing Test, please provide the following information.

The questions are optional and for research purposes only. All information is confidential. If you do not supply an email address, your test access code will be displayed only on this website during this session.

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.

3. Have you had frequent exposure to loud music?

4. What is your age?

5. What is your sex?

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

I choose not to respond
Hispanic/Latino
African-American/Black
Asian
Caucasian/White
American Indian or Alaska Native
Native Hawaiian or Pacific Islander

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

AARP
From a friend or relative
Newspaper
Radio
Television
Online
Flyer
Gift card
Other

Please click on the Submit button to submit your answers, and wait a few moments
to receive your free access code.

Please DO NOT click the button more than once!

The National Hearing Test (NHT) will not sell, share, or otherwise distribute any of your personal
information obtained through the NHT website or telephone test. Your personal information will not
be shared with anyone other than the staff of the testing project and will be used only for this
project. Aggregate project information may be shared with project partners, including AARP. Project
personnel may communicate with you later to determine whether you have sought further assessment of
your hearing or obtained treatment, if advised to do so. This research is funded by the National
Institutes of Health.

Pre-Test Survey

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