Neck Disability Index Questionnaire

This questionnaire has been designed to give us information as to how your neck pain has affected your ability to manage in everyday life. Please answer by checking one box in each section for the statement that best applies to you. We realize you may consider that two or more statements in any one section apply, but please just mark the box that indicates the statement that most clearly describes your problem at this time.

Name *
Date of Birth *
Date of Birth
Today's Date *
Today's Date
Pain Intensity *
Personal Care *
(washing, dressing, etc.)
Lifting *
Reading *
Headaches *
Concentration *
Work *
Driving *
Sleeping *
Recreation *