Dizziness Handicap Inventory
The purpose of this scale is to identify difficulties that you may be experiencing because of your dizziness.
Name
*
First Name
Last Name
Primary Clinic
*
Boulder
Broomfield
Englewood
Lafayette
Longmont
Wheat Ridge
Please check ALWAYS, NO or SOMETIMES to each question. Answer each question only as it pertains to your dizziness problem.
*
Always
Sometimes
No
P1 - Does looking up increase your problem?
E2 - Because of your problem, do you feel frustrated?
F3 - Because of your problem, do you restrict your travel for business or pleasure?
P4 - Does walking down the aisle of a supermarket increase your problem?
F5 - Because of your problem, do you have difficulty getting into or out of bed?
F6 - Does your problem significantly restrict your participation in social activities, such as going out to dinner, going to movies, dancing or to parties?
F7 - Because of your problem, do you have difficulty reading?
F8 - Does performing more ambitious activities like sports, dancing, and household chores, such as sweeping or putting dishes away; increase your problem?
E9 - Because of your problem, are you afraid to leave your home without having someone accompany you?
E10 - Because of your problem, have you been embarrassed in front of others?
P11 - Do quick movements of your head increase your problem?
F12 - Because of your problem, do you avoid heights?
P13 - Does turning over in bed increase your problem?
F14 - Because of your problem, is it difficult for you to do strenuous housework or yard work?
E15 - Because of your problem, are you afraid people may think you're intoxicated?
F16 - Because of your problem, is it difficult for you to go for a walk by yourself?
P17 - Does walking down a sidewalk increase your problem?
E18 - Because of your problem, is it difficult for you to concentrate?
F19 - Because of your problem, is it difficult for you to walk around your house in the dark?
E20 - Because of your problem, are you afraid to stay home alone?
E21 - Because of your problem, do you feel handicapped?
E22 - Has your problem placed stress on your relationship with members of your family or friends?
E23 - Because of your problem, are you depressed?
F24 - Does your problem interfere with your job or household responsibilities?
P25 - Does bending over increase your problem?
Total Score
Total Functional
Total Emotional
Total Physical
Submit
Should be Empty: