Neck Disability Index

Neck Disability Index
Name

First NameLast Name
Date

MonthDayYear
Date
Instructions: This questionnaire has been designed to give the Physical Therapist information as to how your neck pain has affected your ability to manage everyday life.

Please check ONE statement per section which best describes your condition in the past 24 hours.
1. Pain Intensity
2. Personal Care (Washing, Dressing, Etc.)
3. Lifting
4. Reading
5. Headaches
6. Concentration
7. Work
8. Driving
9. Sleeping
10. Recreation and Sports
Score
Percentage
Please place and X on the line to indicate the amount of neck pain you have had In the past 24 hours.

1

2

3

4

5

6

7

8

9

10

1 is No pain at all, 10 is Worst pain possible
Should be Empty: