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Gait & Balance

The safety of our employees and their family, our patients, are paramount above all else. As we learn more about the novel coronavirus and the disease it cases (COVID-19), we all have to do our part to limit its spread. We reply on guidance from the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and local health officials to guide our health and safety precautions as we continue to operate as an essential business that’s part of the nation’s critical infrastructure. 

 
To that aim, Water & Sports Physical Therapy has implemented enhanced screening of all employees and patients who come to a WSPT clinic. Your honest participation in this process is critical to maintaining everyone’s well being during this time.
Please answer the questions listed before coming in for your appointment.

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Dizziness Handicap Inventory (DHI) Functional Index

Does looking up increase your problem?
Because of your problem, do you feel frustrated?
Because of your problem, do you restrict your travel?
Does walking down the aisle of a supermarket increase your problem?
Because of your problem, is it difficult getting in or out of bed?
Does your problem significantly restrict you from social activities?
Does performing more ambitious activities increase your problem?
Because of your problem, are you afraid to leave home by yourself?
Because of your problem, are you embarrassed in front of others?
Do quick head movements increase your problem?
Because of your problem, do you avoid heights?
Does turning over in bed increase your problem?
Because of your problem, is it difficult for you to do strenuous work?
Because of your problem, do you avoid driving in the daytime?
Because of your problem, are you afraid people think you are drunk?
Because of your problem, is it difficult for you to go for a walk alone?
Does walking down a sidewalk increase your problem?
Because of your problem, is it difficult for you to concentrate?
Because of your problem, is it difficult to walk at home in the dark?
Because of your problem, are you afraid to stay home alone?
Because of your problem, do you feel handicapped?
Because of your problem, do you avoid driving your car in the dark?
Has your problem placed stress on personal relationships with others?
Because of your problem, are you depressed?
Patient Name*
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