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Interest Survey: Hearing-Related Research Studies
Amber Farwig
2025-02-19T15:54:04-05:00
Dealing with mild to moderate hearing loss?
We want to hear from you!
Interest Survey: Hearing-Related Research Studies
By completing this survey, I consent to being contacted by Clinilabs by phone, text message, and/or email for consideration in hearing-related research studies.
(Required)
I agree
First Name
(Required)
Last Name
(Required)
Phone Number
(Required)
Email
(Required)
How did you hear about this study? If you were referred by someone, please provide their name in the space below.
(Required)
Are you 18 years of age or older?
(Required)
Yes
No
Are you able to read, write, and speak English without the use of a translator?
(Required)
Yes
No
Which Clinilabs location do you prefer?
(Required)
Eatontown, NJ
Midtown Manhattan, NY
Are you available to attend appointments at Clinilabs within the next month?
(Required)
Yes
No
Do you own an iPhone with iOS version 17.6 or later?
(Required)
Yes
No
Do you wear corrective lenses?
(Required)
Yes, all the time
Yes, but only intermittently when using the computer or to read
No, I use contact lenses
No
Do any of the following statements apply to you? (Check all that apply)
(Required)
I have difficulty hearing in my everyday life
I struggle to hear when talking with other people
I have diagnosed mild to moderate hearing loss
I have diagnosed severe to profound hearing loss
I am deaf
None of the above
Do you currently use any hearing assistive devices? (Check all that apply)
(Required)
I use a PSAP (personal sound amplification product)
I use an Over-the-Counter hearing aid
I use a Prescription hearing aid
I use one of these non-implanted hearing devices: non-implanted bone conductive hearing aid, temporary bone-conducting hearing device
I use one of these implanted hearing devices: cochlear implant, bone anchored hearing device
None of the above
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