The evaluation of patients presenting with vestibular complaints begins with a thorough and structured history and physical examination, which is then augmented by audiologic, vestibular, and radiologic testing. While these ancillary tests are important in establishing a definitive diagnosis, a complete and accurate history and physical exam is critical to narrowing down the differential diagnosis and results in cost-effective use of testing. The first objective is to determine if the dizziness is peripheral or central in origin. This can often be determined by a thorough and structured history of present illness. For instance, if the patient is experiencing vertigo (feeling of movement of self or environment) rather than other sensations such as imbalance, lightheadedness, disequilibrium, or near-syncope, a peripheral cause of vertigo is more likely. Other important questions include the ability to recall a first episode, duration of episodes, severity of episodes, associated symptoms such as hearing loss, inciting factors, and other medical conditions such as medications and history of migraines. By exploring these questions, the cause of the dizziness can often be determined or narrowed. This chapter will discuss the important elements of the history and physical exam with discussion about how these key points will help to narrow down the differential diagnosis. This chapter will conclude with a discussion of several common diagnoses and more specific history and physical exam findings that are suggestive of these conditions.