Hearing Audiogram

Name: _____________________________________________________

Date: ______________________ By: ___________________________

Hearing Audiogram: graph with Frequency measured in Hertz across the Y axis with a range from 125 to 8000 and Hearing Level in Decibels across the X axis with a range from 0 to 110. There is a line that starts at 25 dB and 325 Hz and goes to 25 dB and 750 Hz, rises to 20 dB and 750 Hz and ends at 20 dB and 5000 Hz.

Attach Tympanogram here:




Key:

EAR COLOR AIR
RIGHT RED O
LEFT BLUE X


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