Thoracic Oswestry Injury Survey

This questionnaire is designed to enable us to understand how much your back pain has affected your everyday activities. In the event that two or more of the statements in a category may relate to you, please mark the one answer that most accurately describes your problem. Please answer based upon your average pain over the past two weeks without pain medication.

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  • Name
  • Date Format: MM slash DD slash YYYY
  • Section Break

  • Please select your case manager