Get 06 - Patient Balance And Dizziness Survey - 07-25-12doc

Filling out the 06 - Patient Balance And Dizziness Survey online can help healthcare professionals assess your risk of falls or balance disorders. This guide will provide you with step-by-step instructions to complete the survey effectively.

Follow the steps to complete the survey with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out your personal information at the top of the document. Include your name, age, date, and date of birth as indicated. Ensure all information is accurate, as this will help your healthcare provider understand your situation better.
3. Next, indicate whether you have completed the survey previously by checking the appropriate box. This helps track your progress and history regarding balance and dizziness assessments.
4. Proceed to answer the Balance Self Test questions. For each question, select the box that best describes your answer — Yes or Some Often Times, or No or Never. Be honest in your responses to give a true representation of your condition.
5. Once you have completed all the questions, review your answers to ensure accuracy. This step is critical as it provides essential information to your healthcare provider.
6. At the bottom of the form, provide your signature and any contact information required. This signifies that the information provided is accurate and true to your knowledge.
7. Finally, you can save your changes, download, print, or share the form as needed, ensuring your healthcare provider receives this valuable information during your visit.

Complete your Patient Balance And Dizziness Survey online today for a comprehensive understanding of your health.