Questionnaire d'auto-évaluation

Polyclinique Charles Lemoyne
2944 Taschereau #101
Greenfield Park, QC, J4V 2G8
Tél: (450) 672-2555
Fax: (450) 672-6444

Self-Evaluation Questionnaire:

I often ask others to repeat what they said, or I have the impression that others mumble when they speak. *

True False

I have difficulty understanding conversation in a group setting, on the telephone or television *

True False

I turn up the volume of the radio or television to a level that disturb others. *

True False

Name *

First

Last

Phone Number *

-

If you have experienced one of these situations, we can help you!

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