Virtual Vestibular Rehabilitation Assessment Form

Streamline Your Virtual Vestibular Rehabilitation with Paperform

Managing vestibular disorders requires detailed patient assessments, careful symptom tracking, and consistent follow-up—all of which can be challenging in a traditional clinical setting. Our Virtual Vestibular Rehabilitation Assessment Form brings the entire evaluation process online, making it easier for physical therapists, audiologists, ENT specialists, and rehabilitation clinics to deliver high-quality care through telehealth.

Why This Template Works for Healthcare Providers

Whether you're a physical therapist specializing in vestibular rehabilitation, an ENT practice expanding into telehealth, or a neurologist tracking balance disorders, this template gives you everything you need to conduct thorough remote assessments. Patients can complete their dizziness severity scales, upload balance testing videos, maintain vertigo trigger diaries, and receive personalized fall prevention plans—all before or during your virtual consultation.

The form is designed to mirror the in-person vestibular assessment workflow while taking advantage of what telehealth can offer: detailed pre-visit documentation, video evidence for analysis, and comprehensive symptom tracking that patients complete in their own environment where symptoms naturally occur.

What Makes This Template Essential for Vestibular Rehabilitation

This isn't just a symptom checklist—it's a complete assessment tool built specifically for vestibular rehabilitation professionals. The form includes standardized dizziness severity scales that align with clinical best practices, allowing you to quantify symptoms and track progress over time. Patients can upload videos of their balance attempts, gait patterns, or episodes of dizziness, giving you visual evidence to analyze between sessions.

The vertigo trigger diary component helps identify patterns that might not emerge in a single consultation, while the fall prevention planning section ensures every patient receives personalized safety recommendations based on their specific symptoms and living situation. This comprehensive approach means you're not just assessing—you're creating an actionable care plan from the first interaction.

Designed for Telehealth, Built for Professional Results

Telehealth has transformed healthcare delivery, and vestibular rehabilitation is particularly well-suited to virtual visits when supported by the right tools. This template lets you gather detailed clinical information before your video consultation begins, making your actual face-to-face time more productive and focused on assessment and treatment planning rather than data collection.

The form's conditional logic adapts to each patient's responses, showing relevant follow-up questions based on symptom severity and ensuring you capture the clinical details that matter most. For instance, patients who report frequent falls will see additional questions about their home environment and current safety measures, while those with specific trigger patterns receive targeted questions about those situations.

Seamless Integration with Your Healthcare Workflow

Paperform makes it easy to incorporate this vestibular assessment into your existing practice management systems. Connect submissions directly to your EHR through Stepper workflows (stepper.io), automatically notify your clinical team when high-priority assessments come in, or route different symptom presentations to the appropriate specialists within your practice.

You can embed this form on your practice website, send it via email before scheduled telehealth appointments, or include it in your patient portal. Every submission is securely stored and can be reviewed alongside previous assessments to track rehabilitation progress over time. With Paperform's SOC 2 Type II compliance and robust security measures, you can trust that sensitive patient information remains protected.

Perfect for Multiple Healthcare Settings

This template serves a wide range of healthcare professionals and settings:

• Physical therapy clinics specializing in vestibular rehabilitation can use it for initial assessments and progress tracking
• ENT practices can screen patients before specialist consultations and triage urgent cases
• Neurology practices can gather detailed symptom histories for patients with balance disorders
• Geriatric care providers can assess fall risk and monitor elderly patients with dizziness
• Occupational therapists can evaluate how vestibular symptoms impact daily activities
• Telehealth platforms can offer this as a standard assessment for balance and dizziness complaints

Automate Your Patient Care with Stepper

Take your vestibular rehabilitation practice to the next level by connecting this form to Stepper (stepper.io), Paperform's AI-native workflow builder. When a patient submits their assessment, automatically send their information to your EHR, schedule appropriate follow-up appointments based on symptom severity, trigger email sequences with vestibular exercises tailored to their condition, and alert your clinical team to patients reporting severe symptoms or recent falls.

These automated workflows mean less administrative time and more focus on patient care, while ensuring no assessment falls through the cracks and every patient receives timely follow-up.

HIPAA Consideration

While this template provides professional-grade assessment tools for healthcare providers, please note that Paperform is not a HIPAA-compliant solution. For practices requiring HIPAA compliance, consider this template for pre-screening, general inquiries, or supplementary documentation while using HIPAA-compliant platforms for protected health information.

Start Delivering Better Virtual Vestibular Care Today

Ready to transform your telehealth vestibular assessments? This template gives you everything you need to conduct thorough, professional evaluations that lead to better patient outcomes. With Paperform's intuitive interface, your patients can complete detailed assessments from home while you receive organized, actionable clinical information that supports evidence-based treatment planning.

Whether you're launching a new telehealth vestibular program or improving your existing remote assessment process, this template provides the foundation for delivering exceptional care beyond the four walls of your clinic.