Welcome to our Clinic

You have told us that you would like a consultation about your Dizziness condition…
Please complete the TWO forms below prior to your first appointment.
Note: when you complete each of the two forms on this page, please click the submit button at the end of EACH form.

Help is at hand…

If you have any difficulties with the forms please leave the space blank and we will help you during your visit.
You can also contact reception at admin@healthyhearing.com.au if you have any questions.

FORM ONE: Your Patient Details

  • Date Format: DD slash MM slash YYYY
    If yes, please complete TRACA form.
    If yes, please complete TRQ and THQ forms.
    If yes, please complete DHI form
  • This field is for validation purposes and should be left unchanged.

FORM TWO: Dizziness Handicap Inventory (DHI)

  • Date Format: DD dash MM dash YYYY
  • Dizziness Handicap Inventory (DHI) – Instructions

    Please answer each question as it pertains to your dizziness or unsteadiness problems, specifically considering your condition during the last month. Questions are designed to consider functional (F), physical (P), and emotional (E) impacts.
  • Used with permission from GP Jacobson. Jacobson GP, Newman CW: The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990;116: 424-427