If you have been referred to the Audiology Tinnitus Service, you need to fill in all three questionnaires on this page.

It is important that you complete every questionnaire. First, fill in the Tinnitus Functional Index and press 'Submit'. After this, there are two more forms:

  • HADS Questionnaire
  • Insomnia Severity Index

Please make sure you press 'Submit' on each form.

These questionnaires help us understand how tinnitus affects you. You will be asked to fill them in again before future appointments. This helps us track your progress and see how your treatment is working.

Please complete the questionnaires before each appointment. This gives us more time during the visit to talk about your needs and begin your tinnitus care plan.

If you need help filling in the questionnaires, or you need them on paper instead, please contact our team by: 

Questionnaire 1

Tinnitus Functional Index

Please read the questions below carefully. To answer a question, choose one of the numbers listed. 

You should answer your questions thinking about your experience over the last week. 

Your information

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Over the last week...

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Over the last week, how much has your tinnitus interfered with the things below? 0 = did not interfere at all, 10 = completed interfered

Your ability to concentrate? Required
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Privacy policy Required

Questionnaire 2

HADS questionnaire

Please read every question carefully. Choose the reply that is closest to how you've felt in the last week.

Your information

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Questions

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Questionnaire 3

Insomnia Severity Index

Please rate the severity of your insomnia over the last 2 weeks. 

Your information

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Questions

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Privacy policy Required