Vertigo questionnaire - Dr Eras van der Walt

Your name / U naam *

Email adress / Epos adres

Your age / U ouderdom *

Gender / Geslag *

Male / Manlik
Female / Vroulik

1. How would you describe your symptoms (what exactly does it feel like)? Please be as specific and accurate as possible. Avoid vague words such as 'dizzy', 'funny', 'strange' etc. / Beskryf u simptome. Wees asb so spesifiek as moontlik en vermy vae terme soos 'duiselig' *

2. When exactly did your symptoms start for the very first time? / Wanneer het u simptome vir die eerste keer begin? *

3. How did it change between then and now? Is it increasing in degree, staying the same or improving? / Hoe het dit intussen verander (beter/erger/dieselfde)? *

4. Have you had similar symptoms in the past? / Het u ooit in die verlede soortgelyke simptome gehad? *

Yes / Ja
No / Nee

5. Are the symptoms constantly present or does it come and go? / Is die simptome konstant teenwoordig, of kom en gaan dit? *

Constantly present / Konstant teenwoordig
Comes and goes / Kom en gaan

6. If it comes and goes, does it only vary in degree, or does it come in “attacks” (feeling fairly normal in between)? / As dit kom en gaan, wissel dit net in graad of verdwyn dit by tye geheel en al?

7. If it comes in attacks, how frequent are the attacks and how long do they last? / As dit in aanvalle kom, hoe gereeld is die aanvalle en hoe lank hou dit aan?

8. Is there anything which changes your symptoms or starts an attack? (see vertigo blog for detail) / Is daar enigiets wat die simptome verander of 'n aanval aanbring? *

9. Has your hearing been affected in this time as well, or is your hearing being affected during attacks? / Het u gehoor verander in hierdie tyd, of verander u gehoor tydens die aanvalle? *

10. Do you have any other symptoms, especially during attacks? (see vertigo blog for detail) / Het u enige ander simptome, veral gedurende aanvalle? (sien vertigo-blog vir detail) *

11. What medication (if any) have I tried and what was the effect? / Wat se medikasie het u probeer en wat was die effek daarvan? *

Dr. Eras van der Walt

ENT Specialist

Dr. Eras van der Walt

ENT Specialist

Dr. Eras van der Walt

ENT Specialist

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Dr. Eras van der Walt

ENT Specialist at Cormed, Vanderbijlpark