What Type of Balance Center Are You?

Your Name(Required)

Prefix First Last Suffix

Email(Required)

Phone(Required)

Clinic Name(Required)

Clinic Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Clinic Website(Required)

Specialists(Required)

Services Provided(Required)

Medical Assessment & Diagnosis (by an MD)

Medical Treatment

Surgery

Transtympanic steroid injection

Transtympanic gentamicin injection

Prescribe suppressant medication

Audiological testing

Rehabilitative therapy

Research

Types of Surgery Performed(Required)

Acoustic Neuroma resection

Third window plugging

Endolymphatic sac surgery

Labyrinthectomy

Mastoid surgery for cholesteatoma

Vestibular nerve section

Types of Therapy(Required)

Vestibular rehabilitation therapy

Particle repositioning maneuvers

Balance retraining therapy

Habituation therapy

Fall prevention therapy

Research Focus(Required)

Primary

Limited

Equipment/Testing(Required)

Tell us about how your team works together.

	Not Available	On Location	In Referral Network
Otolaryngologist
Neurotologist
Neurologist/Otoneurologist
Audiologist
Physical Therapist
Occupational Therapist
Psychiatrist or Psychologist

Balance Center Assessment Questionnaire