This questionnaire has been designed to give us information as to how your neck pain has affected your ability to manage in everyday life. Please answer every section and mark in each section only the one box that applies to you. We realise you may consider that two or more statements in any one section relate to you, but please just mark the box that most closely describes your problem.

Section 1: Pain Intensity

Section 2: Personal Care (Washing, Dressing, etc.)

Section 3: Lifting

Section 4: Reading

Section 5: Headaches

Section 6: Concentration

Section 7: Work

Section 8: Driving

Section 9: Sleeping

Section 10: Recreation