Balance & Dizziness Screening Quiz Question Title Please provide us with your full name and email address. Name Email Address Question Title Have you fallen multiple times in the past year? Yes No Question Title Do you experience dizziness when getting up from lying down? Yes No Question Title Do you experience dizziness when first lying down or when washing your hair in the shower? Yes No Question Title Do you have difficulty walking in dark environments? Yes No Question Title Do you experience dizziness or feeling of being unstable with walking in busy environments (i.e. grocery shopping)? Yes No Question Title Have you been limited in performance of exercise activities due to dizziness or feelings of loss of balance? Yes No Question Title Have you restricted your driving at night or in busy environments due to feeling of dizziness? Yes No Next