Neck Disability Index

This questionnaire has been designed to give the doctor information as to how your neck pain has affected your ability to manage in everyday life.  Please answer every section by selecting the one level that applies to you.  We realize you may consider that two of the statements in any one section relate to you, but please just select the ONE which most closely describes your problem.

Name *
Name
Phone *
Phone
Section 1 – Pain Intensity *
Section 2 – Personal Care (washing, dressing, etc.) *
Section 3 – Lifting *
Section 4 – Reading *
Section 5 – Headaches *
Section 6 – Concentration *
Section 7 – Work *
Section 8 – Driving *
Section 9 – Sleeping *
Section 10 – Recreation *