A Brief Hearing Loss Screener - UnitedHealthcareOnlinecom 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your age in the first field. If you are over 70 years, remember to add 1 point.
3. Select your sex by checking either 'Male' or 'Female'. If you select 'Male', add another point.
4. Indicate the highest grade you attended. If it is 12th grade or less, add 1 point.
5. Answer whether you have ever had deafness or trouble hearing. If 'Yes', proceed to Question #5; if 'No', skip to Question #6.
6. For Question #5, indicate if you have seen a doctor about your hearing issues. If 'Yes', add 2 points.
7. In Questions #6 and #7, respond to whether you can hear and understand someone whispering or talking normally from across the room without a hearing aid. Add points as indicated based on your answers.
8. Finally, calculate your total score at the bottom of the form. A score of 3 or more indicates a need for further evaluation.

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