Chicago Dizziness and Hearing

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We will ask you to fill out a 9 page questionnaire, and supply insurance information. We would be very happy for you to bring this in yourself already filled out. This may also save you some time.

• Questionnaires:
  • If you have mainly dizziness or a hearing problem, please fill out the dizzy questionnaire form (pdf format).
  • If you have mainly headaches, please fill out the headache questionnaire
  • If you have something other than dizziness or headaches , please fill out the neurology questionnaire .
• If you would like to have information sent to us from your doctor, please fill out the records request form (pdf format) and send it to the relevant doctors.

More information about what to expect can be found in our policies page.