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 complete the following questionnaire.

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

• Qld Vestibular + Cochlear Clinic Specialist Audiology_Dizziness Questionaire Download

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

• Introduction to balance and vestibular disorders
• What is balance and vestibular dysfunction?
• Causes of balance and vestibular dysfunctions and disorders
• Balance and vestibular dysfunctions and disorders assessment and diagnosis
• Treatment of balance and vestibular dysfunctions and disorders