Chicago Dizziness & Hearing New Patient Intake Questionnaire

Chicago Dizziness & Hearing

http://www.dizzy-doc.com

New patient intake questionnaire

Paper questionnaire

We strongly encourage patients to do the on-line questionnaire as it will expedite your evaluation.

If you nevertheless prefer to hand-write your answers on a paper questionnaire, then please click the link below corresponding to the physician or practitioner you will be seeing. You will then see the PDF (portable document format) file that you can print or download.

Paper questionnaire for Dr. Marcello Cherchi (physician).
Paper questionnaire for Dr. Timothy Hain (physician).
Paper questionnaire for Bartosz Tulicki (physical therapist).
Paper questionnaire for John Chestnut (physical therapist).