• Functional Rating Index

    For use with Neck and/or Back Problems only

  • 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.

    For each item below, please circle the number which most closely describes your condition right now.

  • 1. Pain Intensity
  • 2. Sleeping
  • 3. Personal Care (washing, dressing, etc.)
  • 4. Travel (driving, etc.)
  • 5. Work
  • 6. Recreation
  • 7. Frequency of pain
  • 8. Lifting
  • 9. Walking
  • 10. Standing
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: