Home
Our Clinical Services
Research Institute
Education & Training
Public Involvement
Partnership and Enterprise
Charity
Meet the Team
Testimonials
Resources
Videos
Blogs
Useful links
Questionnaires
Fact Sheets
Misophonia
Tinnitus
Hyperacusis
Auditory Imagery
Noise Sensitivity
Misophonia, Hyperacusis and Tinnitus in Children
Parental Guide for Children with Misophonia
Sensory Processing Disorders in Children
Psycho audiological assessment
Methodology for pinpointing distress
News and press release
Events
Events Calendar
Success stories
Patient Education Programme
Work for us
Contact us
4C hyperacusis management questionnaire
Hyperacusis is intolerance of certain everyday sounds. The sounds maybe perceived as uncomfortably loud, painful, frightening or annoying.
Name of the patient:
Your Email Address:
Please type the email address that this form needs to be sent to.
This is often the email address of your clinician who asked you to complete this form.
For each question please select one number based on how you are feeling now.
1. How confident are you that you are able to carry out your day-to-day tasks despite your hyperacusis?
0
1
2
3
4
5
6
7
8
9
10
2. How confident are you that you are able to socialise and relax despite your hyperacusis?
0
1
2
3
4
5
6
7
8
9
10
3. How confident are you that you can enjoy your life fully despite your hyperacusis?
0
1
2
3
4
5
6
7
8
9
10
4. How confident are you that you can do all the above without using any avoidance behaviour (e.g., use of ear protection, or avoiding certain situations)?
0
1
2
3
4
5
6
7
8
9
10
Submit
For Hearing Healthcare Professionals