Neck Disability Index: Follow-Up and Discharge Visit
Description: This survey is meant to help us obtain information from our patients regarding their current levels of discomfort and capability. Select all answers below that best apply.
Name *
Name
0 = no pain, 10 = very severe pain
Select One
Select One
Select One
1. Pain Intensity *
2. Personal Care (washing, dressing, etc) *
3. Lifting *
4. Headache *
5. Recreation *
6. Reading *
7. Work *
8. Sleeping *
9. Concentration *
10. Driving *

Neck Disability Index © Vernon H. and Mior S., 1991.