Fillable Characteristics of Amplification Tool (COAT) Our goal is (Sacred Heart University)

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Characteristics of Amplification Tool (COAT) Our goal is (Sacred Heart University)

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Characteristics of Amplification Tool (COAT)
Name: Date:
Our goal is to maximize your ability to hear so that you can more easily communicate with others. In
order to reach this goal, it is important that we understand your communication needs, your personal
preferences, and your expectations. By having a better understanding of your needs, we can use our
expertise to recommend the hearing aids that are most appropriate for you. By working together, we
will find the best solution for you.
Please complete the following questions:
1. Please list the top three situations where you would most like to hear better. Be as specific as possible.
2. How important is it for you to hear better? Please select a point on the line.
Not Very Important --- Very Important
3. How motivated are you to wear and use hearing aids? Please select a point on the line.
Not Very Motivated - Very Motivated
4. How well do you think hearing aids will improve your hearing? Please select a point on the line.
Not be helpful -- Greatly improve my at all hearing
5. What is your most important consideration regarding hearing aids? Rank order the following factors
with 1 as the most important and 4 as the least important. Place an X on the line if the item has no
importance to you at all.
Hearing aid size and the ability of others not to see the hearing aids
Improved ability to hear and understand speech
Improved ability to understand speech in noisy situations (e.g., restaurants, parties)
Cost of the hearing aids
6. Do you prefer hearing aids that: (check one)
are totally automatic so that you do not have to make any adjustments to them.
allow you to adjust the volume and change the listening programs as you see fit.
no preference
7. How confident do you feel that you will be successful in using hearing aids?
Not Very Confident -- Very Confident
Thank you for answering the questions.
Your responses will assist us in providing you with the best hearing healthcare.
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Characteristics of Amplification Tool (COAT) Our goal is (Sacred Heart University)

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Completed 25 August 2020

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