Neck Pain PREOP

Neck Pain PREOP


Today


Instructions: This questionnaire has been designed to give the doctor information as to how your neck pain has affected your ability to manage in everyday life. Please answer every section and mark in each section only the ONE box which applies to you. We realize you may consider that two of the statements in any one section relate to you, but please just mark the box which most closely describes your problem.












 
Mercy Hospital participates in the Joint Commission Disease Specific Certification program. As a participating organization, Mercy tracks specific data related to the care of patients having knee replacement, hip replacement and spine surgery. This data is used to improve program quality and patient care experience. Personal patient information is protected.