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Back Pain Questionnaire

Please answer the questions on this form to the best of your ability, as it applies to your current condition. Please check a box in each question category. The following form is used to judge functional performance and goes well beyond pain ratings. This form is based off of the Oswestry Low Back Disability Questionnaire

After filling out this form please click submit. We will review your answers and provide a functional score with some recommendations for help with your problem.