---
title: BPPV Screening Form Template with Dix-Hallpike Test & Vestibular Assessment | Paperform
description: Professional BPPV screening form for healthcare providers. Includes Dix-Hallpike test documentation, symptom triggers, fall risk assessment, and vestibular rehabilitation referrals.
url: "https://paperform.co/templates/benign-paroxysmal-positional-vertigo-bppv-screening-form"
type: static
generatedAt: "2026-03-28T00:43:09.048Z"
---

[← Back to free form templates](/templates/)    ![Benign Paroxysmal Positional Vertigo (BPPV) Screening Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/benign-paroxysmal-positional-vertigo-bppv-screening-form.png)
    [Preview](https://_preview.paperform.co/ai-template/benign-paroxysmal-positional-vertigo-bppv-screening-form) [Use this template for free](/create?ai-template=benign-paroxysmal-positional-vertigo-bppv-screening-form)    [Intake Forms](/templates/category/intake-forms/)[Checklists & Logs](/templates/category/checklists/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Physical Therapist](/templates/role/physical-therapist/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo, affecting millions of people each year. Our BPPV Screening Form helps healthcare providers, physical therapists, and vestibular specialists conduct systematic assessments, document Dix-Hallpike test results, identify symptom triggers, and determine appropriate treatment pathways including vestibular rehabilitation referrals.

This template is designed for ENT specialists, primary care physicians, physical therapists specializing in vestibular rehabilitation, and urgent care facilities. The form captures essential patient information, medical history relevant to vertigo, detailed symptom documentation, positional testing results, fall risk assessment, and generates appropriate recommendations based on clinical findings.

Using Paperform for your BPPV screening means you can customize the assessment to match your clinic's protocols, use conditional logic to show relevant follow-up questions based on test results, and automatically route referrals to vestibular rehabilitation specialists. With secure data handling that's SOC 2 Type II compliant, you can trust that sensitive patient information remains protected while streamlining your vertigo assessment workflow.

Integrate your BPPV screening form with your EHR system, send automatic follow-up emails with home exercises, or use Stepper (stepper.io) to trigger appointment scheduling workflows when vestibular rehabilitation is recommended. Whether you're conducting screenings in a busy clinic or specialized balance center, this form template helps you deliver consistent, thorough assessments that improve patient outcomes and reduce fall risk.
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