Please complete the questionnaires BEFORE each appointment, so that there is enough time in the appointment to discuss your needs and to start your tinnitus management programme.
If you have any difficulty completing the questionnaires, or would like to request them in paper format instead, please contact our Audiology Department on 0191 569 9001, or at email@example.com.
Please read each question below carefully. To answer a question, select ONE of the numbers that is listed for that question. Please answer each question based on your experiences over the past week.
We cannot guarantee the information submitted in this form will be transferred securely to the Trust and you submit this at your own risk.
Please read each item below and choose the reply that comes closest to how you have been feeling in the past week.
Please rate the current (i.e. last two weeks) severity of your insomnia problem(s):