In order for CareOregon to continue covering our work together, please fill out the following assessment.

 

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Thinking about the last 2 weeks, answer the following questions:

Name *
Name
My back pain has spread down my leg(s) at some time in the last 2 weeks *
I have had pain in the shoulder or neck at some time in the last 2 weeks *
I have only walked short distances because of my back pain *
In the last 2 weeks, I have dressed more slowly than usual because of back pain *
It's not really safe for a person with a condition like mine to be physically active *
Worrying thoughts have been going through my mind a lot of the time *
I feel that my back pain is terrible and its never going to get any better *
In general I have not enjoyed all the things I used to enjoy *
Overall, how bothersome has your back pain been in the last 2 weeks? *