Veteran Hearing Health Questionnaire

Full Name

Phone

Noise History

What branch(es) of the military did you serve, when did you serve and where were you stationed outside of the United States?

What was your main occupation in the service?

What noise were you exposed to in the service?

Please list occupational and recreational noises you were exposed to BEFORE your service time (grew up on a farm, hunting, motor sports).

Please list occupational (construction, farming, welding, machine shop, security, etc) and recreational noise you were exposed to AFTER your service time.

Veteran Hearing Health Questionnaire

Noise History

Medical History

Thank you for your service!