Vestibular Rehabilitation at Good Samaritan Hospital

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(937) 734-1000

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(937) 734-8308,
(800) 772-1130 toll free
Monday-Friday, 8:00 am - 4:30 pm

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(937) 734-8316
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Good Samaritan Hospital

2222 Philadelphia Drive
Dayton, OH 45406
(937) 734-2612

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Good Samaritan North Health Center

9000 North Main Street
Dayton, Ohio 45415
(937) 734-6784

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Good Samaritan Health Center - Huber Heights

6251 Good Samaritan Way on Brandt Pike
Huber Heights 45424

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Dayton Heart & Vascular Hospital at Good Samaritan

2222 Philadelphia Drive
Dayton, OH 45406
(937) 734-2612

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Vestibular Rehabilitation Evaluation

Answer the questions below to determine if you could benefit from vestibular rehabilitation therapy.

Questions

Text

Do you feel dizzy with any of the following: turning over in bed (rolling), moving from lying down to sitting, moving from sitting to standing, turning your head or looking up and down?

Answers

Text	Yes
Score	1

Text	No
Score	0

Text

Do you often feel off-balance, unstable, or like you may fall?

Answers

Text	Yes
Score	1

Text	No
Score	0

Text

Have you fallen in the past 3 months due to dizziness?

Answers

Text	Yes
Score	1

Text	No
Score	0

Text

Do you require a cane or walker to walk because of poor balance or a fear of falling?

Answers

Text	Yes
Score	1

Text	No
Score	0

Text

Do you ever experience dizziness when going to tie your shoes or with bending over to pick something up?

Answers

Text	Yes
Score	1

Text	No
Score	0

Text

Do you experience the sensation of spinning (vertigo) when you feel dizzy?

Answers

Text	Yes
Score	1

Text	No
Score	0

Text

Does your dizziness last less than 15-30 seconds when you change postitions or turn your head?

Answers

Text	Yes
Score	1

Text	No
Score	0

Text

Do you experience nausea or vomiting with the onset of dizziness?

Answers

Text	Yes
Score	1

Text	No
Score	0

Bottom Content

*This vestibular rehabilitation evaluation provides general medical information that should be used for informative and educational purposes only. Your results should not be used as a substitute for the personal, professional medical advice of your physician.

Response Content

Vestibular Rehabilitation Evaluation

Thank you for completing the evaluation. Your results are below.

Scoring Ranges

Minimum	0
Maximum	0
Text	Your answers indicate that you do not experience any symptoms that would benefit from vestibular rehabilitation therapy. Learn more about Vestibular Rehabilitation at Good Samaritan Hospital.

Minimum	1
Maximum	8
Text	Your answers indicate that you experience one or more symptoms that would benefit from vestibular rehabilitation therapy. We urge you to discuss your symptoms with your physician. Do you not have a family doctor? Search and Find a Doctor online. Learn more about Vestibular Rehabilitation at Good Samaritan Hospital.