Neck Disability Index
This questionnaire will give your provider information about how your neck condition affects your everyday life. Please answer every section by marking the one statement that applies to you. If two or more statements in one section apply, please mark the one statement that most closely describes your problem.
Sign in to Google to save your progress. Learn more
Name *
Pain intensity *
Sleeping *
Reading *
Concentration *
Work *
Personal care *
Lifting *
Clear selection
Recreation *
Headaches *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy