Skip to Main Content

Situational Vertigo Questionnaire

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

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.”

The categories are:

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

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

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

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

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

Walking down a supermarket aisle

| Download (.pdf) | Print
0 1 2 3 4 N.T.
Not at all Very slightly Somewhat Quite Very much Not tried

Standing in a lift while it stops

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

Standing in a lift while it moves at a steady speed

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

Riding in a car at a steady speed

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

Starting or stopping in a car

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

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

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

Sitting on a bus

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

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.