Summa Health

In the past month, have you felt dizzy (lightheaded, giddy, whirling, spinning, faint)?

Yes

No

In the past month, have you been imbalanced (nearly falling, veering, unstable on your feet)?

Yes

No

In the past month, has dizziness made you stop driving your car or change your driving habits?

Yes

No

In the past month, has imbalance caused you to hold on to things (furniture, walls etc.) to steady yourself?

Yes

No

In the past month, has dizziness or imbalance made you change how fast you get out of bed?

Yes

No

In the past month, have you become careful on how fast you move your head or what position you put it in (looking up or down)?

Yes

No

In the past year, have you fallen?

Yes

No

In the past year, have you had to use a cane or other supportive device when walking?

Yes

No

In the past year, have you noticed any difficulty moving around as quickly as you used to?

Yes

No

In the past year, have your friends or family expressed concern about your sense of balance or mobility?

Yes

No

Balance & Dizziness Self-Assessment Quiz