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Situational Vertigo Questionnaire

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Vertigo is the medical term used for symptoms which patients often describe as feelings of unusual disorientation, dizziness, giddiness, lightheadedness, or unsteadiness.

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Please circle a number to indicate the degree to which each of the situations listed below causes feelings of vertigo, or makes your vertigo worse. If you have never been in one of the situations, then for that item ring “N.T.” for “Not Tried.”

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The categories are:

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Table Graphic Jump Location
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0 1 2 3 4 N.T.
Not at all Very slightly Somewhat a lot Quite Very much Not tried

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Riding as a passenger in a car on straight, flat roads

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Table Graphic Jump Location
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0 1 2 3 4 N.T.
Not at all Very slightly Somewhat a lot Quite Very much Not tried

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Riding as a passenger in a car on winding or bumpy roads

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Table Graphic Jump Location
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0 1 2 3 4 N.T.
Not at all Very slightly Somewhat a lot Quite Very much Not tried

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Walking down a supermarket aisle

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Table Graphic Jump Location
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0 1 2 3 4 N.T.
Not at all Very slightly Somewhat Quite Very much Not tried

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Standing in a lift while it stops

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Table Graphic Jump Location
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0 1 2 3 4 N.T.
Not at all Very slightly Somewhat a lot Quite Very much Not tried

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Standing in a lift while it moves at a steady speed

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Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print
0 1 2 3 4 N.T.
Not at all Very slightly Somewhat a lot Quite Very much Not tried

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Riding in a car at a steady speed

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Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print
0 1 2 3 4 N.T.
Not at all Very slightly Somewhat a lot Quite Very much Not tried

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Starting or stopping in a car

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Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print
0 1 2 3 4 N.T.
Not at all Very slightly Somewhat a lot Quite Very much Not tried

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Standing in the middle of a wide open space (e.g., large field or square)

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Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print
0 1 2 3 4 N.T.
Not at all Very slightly Somewhat a lot Quite Very much Not tried

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Sitting on a bus

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