Table 7.

Hearing health risk appraisal form.

Health condition	Yes	No
1. Do you smoke cigarettes	1	0
2. Do you or a family member believe that you have difficulty hearing and understanding others?	1	0
3. Have you ever been told that you now have diabetes mellitus?	1	0
4. Have you been told that you have cardiovascular sease at this time?	1	0
5. Have you been told that you now have arthritis?	1	0
6. Are you taking aminoglycoside antibiotics, cisplatin, anti inflammatory agent or loop diurectics?	1	0
7. Have you had a fall within the past year?	1	0
8. Have you been told that you have low vision or blindness?	1	0
9. Have you been told that you are suffering from depression?	1	0