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Vestibular Dysfunction: Pre-Implementation Survey 2026
Name
First
Last
Email
Profession & Band
Team/Service
Trust
Please state which tools you intend to pilot (as an individual)
Screening/Triage Tool
Assessment Tool
Please rate your confidence in screening a patient for suitability for vestibular assessment
1 = no confidence, 10 = full confidence
1
2
3
4
5
6
7
8
9
10
Please rate your confidence in completing a vestibular assessment
1 = no confidence, 10 = full confidence. Please select 'not applicable' if this is outside of your scope of practice.
Not applicable
1
2
3
4
5
6
7
8
9
10
If a vestibular assessment is indicated, would you be competent to complete this?
Yes
No
If no, please state who you would refer onto (and whether they are within your own service or external e.g. audiology)
Please rate your confidence in knowledge of onward referral pathways for specialist vestibular rehabilitation
1 = no confidence, 10 = full confidence
1
2
3
4
5
6
7
8
9
10
