Based loosely off the Dizziness Handicap Index. Available in English only.

Categories of questions asked:

• Positional impacts on symptoms (looking up/down, turning in bed, bending etc)
• Symptom experience (no questions about pain)
• Fear or avoidance of activities due to symptoms
• Impact on activities (work, travel, recreation, exercise, sporting)
• Symptom level (best, worst, times of day, with certain activities)
• Impact on focus and concentration
• Depression-like symptoms

Example of questions:

Hi [patient name]! 👋

Does looking up increase your symptoms? Please reply YES, SOMETIMES, or NO to indicate!

Thanks, [provider name]

Hi [patient name]! 👋

Because of your symptoms, do you feel frustrated? Please reply YES, SOMETIMES, or NO to indicate!

Hi [patient name]! 👋