BalanceBelt Information Request

Note: Currently the BalanceBelt is only available in the UK, countries in the European Union, and countries accepting CE marking approval.

BalanceBelt – Info Request

Name(Required)

First Last

Phone

Email(Required)

Address(Required)

Country

Are you a:

Vestibular Patient

Vestibular Healthcare Professional

Other

What type of vestibular dysfunction do you have?

Unilateral vestibular loss

Bilateral vestibular loss

Other