Low Back Questionnaire

REVISED OSWESTRY LOW BACK PAIN DISABILITY QUESTIONNAIRE 

PLEASE READ: This questionnaire is designed to enable us to understand how much your low back/leg pain is affecting your ability to manage everyday activities. Please answer each section by checking the ONE CHOICE that best applies to you today. We realize that you may feel that more than one statement may relate to you, but PLEASE JUST CHECK THE ONE CHOICE WHICH MOST CLOSELY DESCRIBES YOUR PROBLEM RIGHT NOW. 

SECTION 1 - Pain Intensity:
SECTION 2 - Personal Care:
SECTION 3 - Lifting:
SECTION 4 - Walking:
SECTION 5 - Sitting:
SECTION 6 - Standing:
SECTION 7 - Sleeping:
SECTION 8 - Social Life:
SECTION 9 - Traveling:
SECTION 10 - Changing Degree of Pain:

Thank you for taking the time to fill out this form.

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Office Hours

Our Regular Schedule

Arlington Chiropractic

Monday:

9:00 am-7:00 pm

Tuesday:

8:30 am-7:00 pm

Wednesday:

9:00 am-7:00 pm

Thursday:

9:00 am-7:00 pm

Friday:

8:00 am-5:00 pm

Saturday:

8:00 am-1:00 pm

Sunday:

Closed