TechWrite Form: Functional Rating Index (Neck and/or Back problems)

In order to properly assess your condition, we must understand how much your neck and/or back problems have affected your ability to manage everyday activities. Please select a response which most closely describes your condition right now.


Personal Information

Section 1: Pain Intensity

Section 2: Sleeping

Section 3: Personal Care (washing, dressing, etc.)

Section 4: Travel (driving, etc.)

Section 5: Work

Section 6:Recreation

Section 7: Frequency of pain

Section 8: Lifting

Section 9: Walking

Section 10: Standing