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Dizziness Handicap Inventory

Full Name *

Today's Date: *

Answer each question as it pertains to dizziness or unsteadiness problems, specifically considering your condition during the last month.

1. Does looking up increase your problem? *

Yes

Sometimes

2. Because of your problem, do you feel frustrated? *

Yes

Sometimes

3. Because of your problem, do you restrict your travel for business or recreation? *

Yes

Sometimes

4. Does walking down the aisle of a supermarket increase your problems? *

Yes

Sometimes

5. Because of your problem, do you have difficulty getting into or out of bed? *

Yes

Sometimes

6. Does your problem significantly restrict your participation in social activities, such as going out to dinner, going to the movies, dancing, or going to parties? *

Yes

Sometimes

7. Because of your problem, do you have difficulty reading? *

Yes

Sometimes

8. Does performing more ambitious activities such as sports, dancing, household chores (sweeping or putting dishes away) increase your problems? *

Yes

Sometimes

9. Because of your problem, are you afraid to leave your home without having without having someone accompany you? *

Yes

Sometimes

10. Because of your problem have you been embarrassed in front of others? *

Yes

Sometimes

11. Do quick movements of your head increase your problem? *

Yes

Sometimes

12. Because of your problem, do you avoid heights? *

Yes

Sometimes

13. Does turning over in bed increase your problem? *

Yes

Sometimes

14. Because of your problem, is it difficult for you to do strenuous homework or yard work? *

Yes

Sometiems

15. Because of your problem, are you afraid people may think you are intoxicated? *

Yes

Sometimes

16. Because of your problem, is it difficult for you to go for a walk by yourself? *

Yes

Sometimes

17. Does walking down a sidewalk increase your problem? *

Yes

Sometimes

18. Because of your problem, is it difficult for you to concentrate *

Yes

Sometimes

19. Because of your problem, is it difficult for you to walk around your house in the dark? *

Yes

Sometimes

20. Because of your problem, are you afraid to stay home alone? *

Yes

Sometimes

21. Because of your problem, do you feel handicapped? *

Yes

Sometimes

22. Has the problem placed stress on your relationships with members of your family or friends? *

Yes

Sometimes

23. Because of your problem, are you depressed? *

Yes

Sometimes

24. Does your problem interfere with your job or household responsibilities? *

Yes

Sometimes

25. Does bending over increase your problem? *

Yes

Sometimes

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Dizziness Handicap Inventory Score

Captcha

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25909 Pala Ste. 190

Mission Viejo, CA 92691

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New! Office Hours

Monday, Tuesday, Thursday

8:30am – 12:30pm & 2:30pm - 6:00pm

Wednesday

4:00pm - 6:00pm

8:30am - 12:30pm

1 Saturday/Month

9:00am - 12:30pm by Appointment Only!

Massage Hours

Monday 8:00am - 6:00pm

Tuesday 9:00am - 7:00pm

Wednesday 1:15pm - 6:15pm

Thursday 9:00am - 6:00pm

Friday Stretch 8:30am - 12:30pm

Saturday 8:30am - 5:15pm

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