Neck Disability Index (NDI) Questionnaire template
A free online Neck Disability Index (NDI) questionnaire with all 10 sections and scoring instructions. Track neck pain outcomes at evaluation, re-assessment, and discharge without paper forms.
Neck Disability Index (NDI) Questionnaire
Neck Disability Index (Vernon H, Mior S, 1991). This questionnaire shows how neck pain affects your everyday life. In each section, choose the ONE statement that best describes you today. If two seem to apply, pick the closest one.
Patient name *
Visit type *
Initial evaluation
Re-assessment / progress check
Discharge
Section 1 — Pain intensity
Pain intensity *
0 — I have no pain at the moment
1 — The pain is very mild at the moment
2 — The pain is moderate at the moment
3 — The pain is fairly severe at the moment
4 — The pain is very severe at the moment
5 — The pain is the worst imaginable at the moment
Section 2 — Personal care (washing, dressing, etc.)
Personal care *
0 — I can look after myself normally without causing extra pain
1 — I can look after myself normally but it causes extra pain
2 — It is painful to look after myself and I am slow and careful
3 — I need some help but can manage most of my personal care
4 — I need help every day in most aspects of self care
5 — I do not get dressed, I wash with difficulty, and stay in bed
Section 3 — Lifting
Lifting *
0 — I can lift heavy weights without extra pain
1 — I can lift heavy weights but it gives extra pain
2 — Pain prevents me lifting heavy weights off the floor, but I can manage if they are conveniently placed
3 — Pain prevents me lifting heavy weights, but I can manage light to medium weights if they are conveniently placed
4 — I can lift very light weights
5 — I cannot lift or carry anything
Section 4 — Reading
Reading *
0 — I can read as much as I want with no pain in my neck
1 — I can read as much as I want with slight pain in my neck
2 — I can read as much as I want with moderate pain in my neck
3 — I can't read as much as I want because of moderate pain in my neck
4 — I can hardly read at all because of severe pain in my neck
5 — I cannot read at all
Section 5 — Headaches
Headaches *
0 — I have no headaches at all
1 — I have slight headaches, which come infrequently
2 — I have moderate headaches, which come infrequently
3 — I have moderate headaches, which come frequently
4 — I have severe headaches, which come frequently
5 — I have headaches almost all the time
Section 6 — Concentration
Concentration *
0 — I can concentrate fully when I want to with no difficulty
1 — I can concentrate fully when I want to with slight difficulty
2 — I have a fair degree of difficulty concentrating when I want to
3 — I have a lot of difficulty concentrating when I want to
4 — I have a great deal of difficulty concentrating when I want to
5 — I cannot concentrate at all
Section 7 — Work
Work *
0 — I can do as much work as I want to
1 — I can only do my usual work, but no more
2 — I can do most of my usual work, but no more
3 — I cannot do my usual work
4 — I can hardly do any work at all
5 — I can't do any work at all
Section 8 — Driving
If you don't drive for reasons unrelated to your neck, leave this section blank.
Driving
0 — I can drive without any neck pain
1 — I can drive as long as I want with slight pain in my neck
2 — I can drive as long as I want with moderate pain in my neck
3 — I can't drive as long as I want because of moderate pain in my neck
4 — I can hardly drive at all because of severe pain in my neck
5 — I cannot drive at all
Section 9 — Sleeping
Sleeping *
0 — I have no trouble sleeping
1 — My sleep is slightly disturbed (less than 1 hr sleepless)
2 — My sleep is mildly disturbed (1–2 hrs sleepless)
3 — My sleep is moderately disturbed (2–3 hrs sleepless)
4 — My sleep is greatly disturbed (3–5 hrs sleepless)
5 — My sleep is completely disturbed (5–7 hrs sleepless)
Section 10 — Recreation
Recreation *
0 — I can do all my recreation activities with no neck pain at all
1 — I can do all my recreation activities, with some pain in my neck
2 — I can do most, but not all, of my usual recreation activities because of neck pain
3 — I can do only a few of my usual recreation activities because of neck pain
4 — I can hardly do any recreation activities because of neck pain
5 — I can't do any recreation activities at all
Anything else your therapist should know about your neck?
Scoring: add the section scores (0–5 each). Divide by 5 × the number of sections answered, then multiply by 100 for a percentage.
The 10 sections of the Neck Disability Index
Pain intensity
Personal care
Lifting
Reading
Headaches
Concentration
Work
Driving
Sleeping
Recreation
What's included
Patient name
Visit type
Pain intensity
Personal care
Lifting
Reading
Headaches
Concentration
Work
Driving
Sleeping
Recreation
Anything else your therapist should know about your neck?
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This template is a starting point, not legal or medical advice, and using it does not by itself make your practice HIPAA compliant. To collect patient health information on TendForm, use the HIPAA plan with a signed Business Associate Agreement, and have your own counsel review consent and policy wording.
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