Syncope is a frequent cause for presentation to emergency departments and urgent-care clinics. The physician should establish a confident causal diagnosis, assess prognostic implications, and provide appropriate advice to prevent recurrences. An organized approach is needed to the assessment of the patient with syncope, including a careful initial examination as well as application of specialized syncope evaluation units and structured questionnaires for history taking. The initial patient evaluation, particularly a detailed medical history, is the key to identifying the most likely diagnosis. Based on these findings, subsequent diagnostic tests can be chosen to confirm the clinical suspicion.