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Balance and Vestibular Disorder Questionnaire

 Balance and Vestibular Disorders Questionnaire

In order to assist our diagnosis we ask that any patients booked in for a Balance or Vestibular Assessment completes the following questionnaire .

Please download the PDF, complete the questionnaire and submit it to the email address in the document.

Pre-appointment preparations

Please note the following preparations if you are coming in for a Balance or Vestibular Assessment:

  • Do not wear make-up
  • Do not eat anything for 8 hours prior
  • Do not have caffeine for 12 hours prior
  • Do not have alcohol for 48 hours prior
  • Do not have nicotine (cigarettes, gum, patches etc) for 12 hours prior
  • Do not take tranquilisers, sedatives, vestibular suppressants (eg Stemetil, Serc) or painkillers for 24 hours prior

Read more about balance and vestibular disorders

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