Neck Pain - Disability Questionnaire

Thank you for taking the time to complete this questionnaire. How your pain affects your quality of life is an important part of your assessment which will help us move forward with management options.

This questionnaire has been designed to give us information as to how your neck pain has affected your ability to manage everyday life. Please answer every section by selecting the option that best describes your condition today.

We realize you may feel that two of the statements in any one section relate to you, but please just select the option which most closely describes your current condition

Northland Orthopaedic Clinic

15 Kensington Avenue



P: 09 4379028 F: 09 4379033 E: