Dizziness Questionnaire

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PATIENT QUESTIONNAIRE PATIENT NAME: DATE
PATIENT QUESTIONNAIRE PATIENT NAME: _____ DATE: _____ Equilibrium disorders may appear with a variety of symptoms. Some individuals may experience dizziness or vertigo while others may have imbalance or unsteadiness. Please spend a few minutes answering the ... Access Content

HEAD AND NECK SURGERY ASSOCIATES
HEAD AND NECK SURGERY ASSOCIATES DIZZINESS QUESTIONNAIRE Name: Date: When did the dizziness first occur: Please check the answer Few days ago Few weeks ago Few months ago Years ago, how many? Date My dizziness is constant No Yes ... Return Doc

Concussion Grading Systems - Wikipedia, The Free Encyclopedia
Concussion grading systems are sets of criteria used in sports medicine to determine the severity, or grade, of a concussion, the mildest form of traumatic brain injury. ... Read Article

Dizziness & Balance Medical History Questionnaire
5018 NE 15th Ave · Portland, OR 97211 · fax: (503) 229-8064 · (800) 837-8428 · info@vestibular.org · vestibular.org Dizziness & Balance Medical History Questionnaire ... Get Document

DIZZINESS AND VERTIGO QUESTIONNAIRE
Rev 11/20 ks, Rev 9/24/10 MEMORIAL NEUROLOGICAL ASSOCIATION William H. Fleming, III, M.D. 7777 Southwest Freeway, Suite 900 Medical Neurology ... Visit Document

Dizziness Handicap Inventory Questionnaire
Dizziness Handicap Inventory Questionnaire Name: _____DOB:_____ Date:_____ Instructions: The purpose of this scale is to identify difficulties that you may be experiencing because of your dizziness ... Retrieve Document

Dizziness Questionnaire - ENT
Dizziness Questionnaire Patient’s Name:_____ Date:_____ When you are dizzy do you experience any of the following sensations? ... Retrieve Content

DIZZINESS QUESTIONNAIRE - Midwest ENT Consultants
1 dizziness questionnaire patient name:_____ date:_____ please answer all questions i. when you are “dizzy”, do you experience any of the ... Doc Viewer

Dizziness Questionnaire - Indiana Total Therapy
Dizziness Questionnaire Name Age Gender Date 1. When did you first notice your dizziness? 2. ... Retrieve Content

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The Dizziness Handicap Inventory ( DHI )
DHI Scoring Instructions The patient is asked to answer each question as it pertains to dizziness or unsteadiness problems, specifically considering their condition during the last month. ... View Doc

Dizziness Handicap Inventory - MSU Rehabilitation
Dizziness Handicap Inventory . Instructions: The purpose of this scale is to identify difficulties that you may be experiencing because of your dizziness. ... Document Viewer

Vestibular Questionnaire - Ear Doctor
Vestibular Questionnaire Name: _____ MR#: _____ Date: _____ Address Nausea or vomiting Dizziness occurs in attacks Pressure in the head Dysequilibrium – sensation of falling to one side Spinning Other ... Access Document

DIZZINESS QUESTIONNAIRE - House Ear Clinic
(Please turn page and finish questionnaire.) HOUSE EAR CLINIC, INC. 2100 West Third Street, 1st Floor Los Angeles, California 90057 DIZZINESS QUESTIONNAIRE ... Retrieve Content

Dizziness History Questionnaire - MD Neurology
1 Dizziness History Questionnaire Name: DOB: Date: Duration of symptoms: Currently, my dizziness… ____is constant. ... Read Document

DIZZINESS QUESTIONNAIRE - West Portland Neurology
Dizziness Questionnaire West Portland Neurology Page 3 12) Do you suffer from unusual and frequent headaches? ⃝ Yes ⃝ No If so, please answer the following questions: ... Access Document

Dizzy Questionnaire - Entmanatee.com
Balance \\ Dizzy Questionnaire Check the area below that describes you best…. How long have the symptoms been going on? ( ) days ( ) weeks ( ) months ( ) years Have you had falls? ( ) yes ( ) no Description of the dizziness? ( ) feeling of being on a boat ( ) lightheadedness ( ) sensation of ... Doc Retrieval

Dizziness And Unsteadiness Questionnaire
24422 Avenida de la Carlota Phone : (949) 340-6927 Suite 190 Fax : (949) 215-7246 Laguna Hills, CA 92653 www.completebalancesolutions.com ... Retrieve Content