Neck and Back Pain Self Test
Are You Tired of Neck or Back Pain?
Are You Looking For Help?
This questionnaire has been designed to give the Chiropractor information as to how your neck or back pain has affected your ability to manage everyday life. Please answer every section and mark only ONE box that applies to you. We realize that you may consider that two of the same statements in any one section relate to you, but please just mark the box that most closely describes your problem.