Transcription of Neck Index - Logon
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Neck Index - Logon
neck IndexACN Group, Inc. Use Only rev 3/27/2003 Patient NameDateThis questionnaire will give your provider information about how your neck condition affects your everyday answer every section by marking the one statement that applies to you. If two or more statements in onesection apply, please mark the one statement that most closely describes your IntensityI have no pain at the pain is very mild at the pain comes and goes and is pain is fairly severe at the pain is very severe at the pain is the worst imaginable at the have no trouble sleep is slightly disturbed (less than 1 hour sleepless).My sleep is mildly disturbed (1-2 hours sleepless).My sleep is completely disturbed (5-7 hours sleepless).My sleep is moderately disturbed (2-3 hours sleepless).My sleep is greatly disturbed (3-5 hours sleepless).ReadingI can read as much as I want with no neck can read as much as I want with slight neck can read as much as I want with moderate neck cannot read at all because of neck cannot read as much as I want because of moderate neck can hardly read at all because of severe neck can concentrate fully when I want with no can concentrate fully when I want with slight have a fair degree of difficulty concentrating when I cannot concentrate at have a lot of difficulty concentrat
Neck Index ACN Group, Inc. Use Onlyrev 3/27/2003 Patient Name Date This questionnaire will give your provider information about how your neck condition affects your everyday life.
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