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TINNITUS FUNCTIONAL INDEX

Today's Date
Year
Month
Day

Please read each question below carefully. To answer a question, select ONE of the numbers that is listed for that question.

Section I

Over the past week...

Section SC

Over the PAST WEEK...

Section C

Over the PAST WEEK, how much did your tinnitus interfere with...

Section SL

Over the PAST WEEK...

Section A

Over the PAST WEEK, how much has your tinnitus interfered with...

Section R

Over the PAST WEEK, how much has your tinnitus interfered with...

Section Q

Over the PAST WEEK, how much has your tinnitus interfered with...

Section E

Over the PAST WEEK...

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