Vertigo and balance! Google

1

How would you explain your dizziness?

Lightheaded

Disorientation

Full sense of motion that you are moving

Full sense of motion, the world is moving

2

Are your dizziness symptoms? (check one)

Recent

Reoccurring comes and goes

Chronic to some degree always there

3

What is the typical duration of your symptoms (check one)

A few seconds

Several seconds to a minute

Several minutes to an hour

Days

Weeks

4

Do you have hearing loss with your vertigo or dizziness?

Yes

No

5

Do you have any ringing in your ears with your vertigo or dizziness?

Yes

No

6

Can your symptoms of dizziness or vertigo be reduced by visual fixing on a target?

Yes

No

8

Do any of the following movements cause your symptoms to get worse?

Turning to the right

Turning to the left

Suddenly, stopping in a car or plane landing

Starting to move forward in a car or plane

Moving side to side

Suddenly moving up or down in an elevator

9

Can positional changes such as turning over in bed, bending over and then standing up or tilting your head, trigger your symptoms

Yes

No

10

Are your symptoms prompted by eye or head movements and then decrease in less than one minute?

Yes

No

11

Do you experience a throbbing headache before or after your episodes of dizziness or vertigo?

Yes

No

12

Is there anything that makes your vertigo or dizziness worse?

13

Does anything help your symptoms?

14

What’s Next to Get Your Results?

15

Are you looking for some guided help for your condition?* This field is required.

Yes

No

16

Name* This field is required.

First Name

Last Name

17

Where should we send your personal video?* This field is required.

example@example.com

18

Let Dr. Hugh guide you with a video made just for you. Share your phone number, and we'll text you a link to your personalized assessment!* This field is required.

Area Code

Phone Number