Vestibular IntakeName First Last Date Section BreakPlease describe your complaint in your own words WITHOUT using the word "dizzy."How would you describe your complaint (check all that apply) Dizziness Vertigo Unsteadiness Giddiness Lightheadedness OtherIf you selected "other" above, please explain here:Have you seen anyone else for this present complaint? No YesIf yes, please complete below.
