Neck Pain Questionnaire

Name *
Name
Can you sleep at night without neck pain interfering?
Can you manage daily activities without neck pain reducing activity levels?
Can you manage daily activities without help from others?
Can you manage putting on your clothes in the morning without taking more time than usual
Can you bend over the washing basin to brush your teeth without getting neck pain?
Do you spend more time than usual at home because of neck pain?
Are you prevented from lifting objects between 2-4kg due to neck pain?
Have you reduced your reading activity due to neck pain?
Have you been bothered by headaches during those times that you have neck pain?
Do you feel that your ability to concentrate is reduced due to back neck pain?
Are you prevented from participating in your usual leisure time activities due to back pain?
Do you remain in bed longer than usual due to back pain
Do you feel that neck pain has influenced your emotional relationship with your nearest family?
Have you had to give up social contact with other people during the past two weeks due to neck pain?
Do you feel that neck pain will influence your future?