Dizziness Handicap Inventory (DHI)
Does looking up increase your problem?
*
Please Select
Yes
Sometimes
No
Because of your problem do you feel frustrated?
*
Please Select
Yes
Sometimes
No
Because of your problem do you restrict your travel for business or recreation?
*
Please Select
Yes
Sometimes
No
Does walking down the aisle of a supermarket increase your problem?
*
Please Select
Yes
Sometimes
No
Because of your problem do you have difficulty getting into or out of bed?
*
Please Select
Yes
Sometimes
No
Does your problem significantly restrict your participation in social activities, such as going out to dinner, going to the movies, dancing, or to parties?
*
Please Select
Yes
Sometimes
No
Because of your problem do you have difficulty reading?
*
Please Select
Yes
Sometimes
No
Does performing more ambitious activities like sports, dancing, household chores such as sweeping or putting dishes away, increase your problem?
*
Please Select
Yes
Sometimes
No
Because of your problem are you afraid to leave your home without having someone accompany you?
*
Please Select
Yes
Sometimes
No
Because of your problem have you been embarassed in front of others?
*
Please Select
Yes
Sometimes
No
Do quick movements of your head increase your problem?
*
Please Select
Yes
Sometimes
No
Because of your problem do you avoid heights?
*
Please Select
Yes
Sometimes
No
Does turning over in bed increase your problem?
*
Please Select
Yes
Sometimes
No
Because of your problem is it difficult for you to do strenuous housework or yardwork?
*
Please Select
Yes
Sometimes
No
Because of your problem are you afraid people may think that you are intoxicated?
*
Please Select
Yes
Sometimes
No
Because of your problem, is it difficult for you to go for a walk by yourself?
*
Please Select
Yes
Sometimes
No
Does walking down a sidewalk increase your problem?
*
Please Select
Yes
Sometimes
No
Because of your problem, is it difficult for you to concentrate?
*
Please Select
Yes
Sometimes
No
Because of your problem, is it difficult for you to walk around your house in the dark?
*
Please Select
Yes
Sometimes
No
Because of your problem are you afraid to stay home alone?
*
Please Select
Yes
Sometimes
No
Because of your problem do you feel handicapped?
*
Please Select
Yes
Sometimes
No
Has your problem placed stress on your relationships with members of your family and friends?
*
Please Select
Yes
Sometimes
No
Because of your problem are you depressed?
*
Please Select
Yes
Sometimes
No
Does your problem interfere with your job or household responsibilities?
*
Please Select
Yes
Sometimes
No
Does bending over increase your problem?
*
Please Select
Yes
Sometimes
No
Calculation
Name
*
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Signature
Submit
Should be Empty: