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Hyperacusis
Misophonia
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Hyperacusis Impact Survey

How bad is my hyperacusis? How much is it impacting my life?

By taking our in-depth Hyperacusis Impact Survey, we can determine the severity of your decreased sound tolerance.

Within minutes, we will also send your results via e-mail along with our recommendations for you to find the relief you deserve.

If at any point you have questions or concerns, please give us a call.

Hiddent Data Don’t Remove

Step 1 of 9

11%

Please read each question below carefully.

Over the past week...
What percentage of your time awake were you consciously AWARE OF your hyperacusis?*
0% Never - 100% Always
- 0%
- 10%
- 20%
- 30%
- 40%
- 50%
- 60%
- 70%
- 80%
- 90%
- 100%
How STRONG was your hyperacusis?*
(0) Not at all - (10) Extremely
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
What percentage of your time awake were you ANNOYED by your hyperacusis?*
0% Never - 100% Always
- 0%
- 10%
- 20%
- 30%
- 40%
- 50%
- 60%
- 70%
- 80%
- 90%
- 100%

Over the past week...
Did you feel IN CONTROL in regard to your hyperacusis?*
(0) Very much in control - (10) Never in control
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How easy was it for you to COPE with your hyperacusis?*
(0) Very easy - (10) Impossible
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How easy was it for you to IGNORE your hyperacusis?*
(0) Very easy - (10) Impossible
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Over the past week, how much did your hyperacusis interfere with...
Your ability to CONCENTRATE?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ability to THINK CLEARLY?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ability to FOCUS ATTENTION on other things besides your hyperacusis?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Over the past week...
How often did your hyperacusis make it difficult to FALL ASLEEP or STAY ASLEEP?*
(0) Never - (10) Always
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How often did your hyperacusis cause you difficulty in getting AS MUCH SLEEP as you needed?*
(0) Never - (10) Always
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How much of the time did your hyperacusis keep you from SLEEPING as DEEPLY or as PEACEFULLY as you would have liked?*
(0) Never - (10) Always
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Over the past week, how much has your hyperacusis interfered with...
Your ability to HEAR CLEARLY?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ability to UNDERSTAND PEOPLE who are talking?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ability to FOLLOW CONVERSATIONS in a group or at meetings?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Over the past week, how much has your hyperacusis interfered with...
Your QUIET RESTING ACTIVITIES?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ability to RELAX?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ability to enjoy "PEACE AND QUIET"?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Over the past week, how much has your hyperacusis interfered with...
Your enjoyment of SOCIAL ACTIVITIES?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your ENJOYMENT OF LIFE?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Your RELATIONSHIPS with family, friends, and other people?*
(0) Did not interfere - (10) Completely interfered
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How often did your hyperacusis cause you to have difficulty performing your WORK or OTHER TASKS, such as home maintenance, school work, or caring for children or others?*
(0) Never - (10) Always
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Over the past week...
How ANXIOUS or WORRIED has your hyperacusis made you feel?*
(0) Not at all - (10) Extremely
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How BOTHERED or UPSET have you been because of your hyperacusis?*
(0) Not at all - (10) Extremely
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
How DEPRESSED were you because of your hyperacusis?*
(0) Not at all - (10) Extremely depressed
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Within minutes, we will also send your results via e-mail along with our recommendations for you to find the relief you deserve.
Name*
First Last
Email*

LOCATIONS

COME IN FOR A VISIT

COLORADO

Fort Collins

4703 E Boardwalk Dr #b2
Fort Collins, CO 80525

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
(970) 672-1410

schedule an appointment

Westminster

12001 Tejon St #124
Westminster, CO 80234

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
Friday: 8:30 am – 1:00 pm
(720) 259-9750

schedule an appointment

Golden

1030 Johnson Road #130
Golden, CO 80401

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
Friday: 8:30 am – 1:00 pm
(720) 259-2793

schedule an appointment

Centennial

15450 East Orchard Road
Centennial, CO 80016

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
Friday: 8:30 am – 1:00 pm
(720) 381-3020

schedule an appointment

Highlands Ranch

200 Plaza Drive #110
Highlands Ranch, CO 80129

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
Friday: 8:30 am – 1:00 pm
(720) 627-6378

schedule an appointment

Denver

55 Madison Street #550
Denver, CO 80206

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
Friday: 8:30 am – 1:00 pm
(720) 863-4366

schedule an appointment

Arizona

Mesa

4824 East Baseline Rd #102
Mesa, AZ 85206

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
(480) 389-2337

schedule an appointment

Peoria

16155 N. 83rd Avenue #101
Peoria, AZ 85382

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
(623) 209-7766

schedule an appointment

Scottsdale

9465 E Ironwood Square Dr #102
Scottsdale, AZ 85258

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
Friday: 8:30 am – 1:00 pm
(480) 751-4200

schedule an appointment

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Locations

Centennial, CO
Denver, CO
Fort Collins, CO
Golden, CO
Highlands Ranch, CO
Westminster, CO
Mesa, AZ
Peoria, AZ
Scottsdale, AZ

Mesa

4824 East Baseline Rd #102
Mesa, AZ 85206

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
Friday: 8:30 am – 1:00 pm
(480) 389-2337

schedule an appointment

Peoria

16155 N. 83rd Avenue #101
Peoria, AZ 85382

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
(623) 209-7766

schedule an appointment

Scottsdale

9465 E Ironwood Square Dr #102
Scottsdale, AZ 85258

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
Fri: 8:30 am – 1:00 pm
(480) 751-4200

schedule an appointment

Fort Collins

4703 E Boardwalk Dr #b2
Fort Collins, CO 80525

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
(970) 672-1410

schedule an appointment

Westminster

12001 Tejon St #124
Westminster, CO 80234

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
Friday: 8:30 am – 1:00 pm
(720) 259-9750

schedule an appointment

Golden

1030 Johnson Road #130
Golden, CO 80401

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
Friday: 8:30 am – 1:00 pm
(720) 259-2793

schedule an appointment

Centennial

15450 East Orchard Road
Centennial, CO 80016

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
Fri: 8:30 am – 1:00 pm
(720) 381-3020

schedule an appointment

Highlands Ranch

200 Plaza Drive #110
Highlands Ranch, Colorado 80129

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
Fri: 8:30 am – 1:00 pm
(720) 627-6378

schedule an appointment

Denver

55 Madison Street #550
Denver, CO 80206

Hours of Operation:
Mon – Thur: 8:30 am – 5:00 pm
Fri: 8:30 am – 1:00 pm
(720) 863-4366

schedule an appointment