Neck Pain

This questionnaire has been designed to give your therapist information as to how your neck pain has affected your ability to manage in everyday life. Please answer every question by selecting the one choice that best describes your condition today.

 

We realize you may feel that two of the statements may describe your condition, but please mark only the box which most closely describes your current condition.

Pain Intensity

Personal Care (Washing, Dressing, etc.)

Lifting

Reading

Headaches

Concentration

Work

Driving

Sleeping

Recreation