Neck Pain Questionnaire
What a neck pain questionnaire asks in a pain clinic, with sample questions for clinic staff.
A neck pain questionnaire records neck and arm pain, how head movement changes it, and past imaging and treatment before a pain clinic visit. The questions here come from neck and arm items on Naples Comprehensive Health, UCLA Health, and Stony Brook Medicine intake forms.
Neck pain questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a neck pain questionnaire in the patient's own language, strictly following the practice's instructions.
- Intake before the visit. Patients answer online before they arrive, or at a kiosk when they check in.
- Answers ready for the clinician. Clinicians see what the patient said before the visit starts.
- Less workload at the front desk. Staff spend less time handing out forms and entering answers by hand.
- Key details at a glance. The care team sees what matters up front and decides who needs attention first.
The form becomes a natural conversation: patients answer by talking, in their own words. AI Doctor is an information and patient-assistance interface. It collects answers for the care team to review. It doesn't diagnose, triage, or give treatment advice.
Sample neck pain questionnaire questions
Questions built from spine and pain intake forms, written out so you can see the level of detail. Every practice words its own form differently.
- Is your neck or your arm worse?Pain areas
- Which arm does the pain reach?Pain areas
- How strong is your neck pain, 0 to 10?Pain level
- How strong is your arm pain, 0 to 10?Pain level
- Does looking upward change your pain?Head movement
- Does looking downward change your pain?Head movement
- When did your symptoms first start?Symptom timing
- When did your symptoms get worse?Symptom timing
- Have you had an MRI of your neck?Imaging tests
- Have you had a neck X-ray or CT scan?Imaging tests
- Has an injection helped your neck pain?Past treatments
- Did physical therapy help your neck?Past treatments
These are examples to read, not a form to fill in.
Neck pain questionnaire: FAQ
What does a neck pain questionnaire ask?
The sample questions on this page are based on Naples Comprehensive Health and UCLA Health spine forms and Stony Brook Medicine pain center intake forms. This page groups them into six areas: pain areas, pain level, head movement, symptom timing, imaging tests, and past treatments.
Who fills in a neck pain questionnaire, and when?
A patient with neck or arm pain, as part of new patient paperwork. UCLA Health uses one spine questionnaire for both neck and back problems.
Is it the same as a cervical pain intake?
It can be part of one. A multispecialty group's pain and spine intake form lists neck pain as one checkbox in a wider intake.
How does it record arm pain?
The Naples Comprehensive Health form has separate 0 to 10 scales for neck pain and arm pain. The UCLA Health form asks which is worse.
Does it ask about the dominant hand?
Yes. The UCLA Health form asks for the dominant hand, and a multispecialty group's form asks whether the patient is right or left handed.
What happens after the neck pain questionnaire is completed?
The pain clinic's care team goes through the answers. AI Doctor only collects them and doesn't suggest a cause for the pain.
Does AI Doctor give medical advice?
No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.
Can patient answers stay on our own servers?
Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.
Set up your AI Doctor in Genesis AI Avatar Studio
Genesis AI Avatar Studio is where you set up, test, and publish AI avatars for your website, mobile app, or Holobox. No coding or technical skills needed.
- 01Choose the AI Doctor avatar.
- 02Add your practice's FAQs and visit information.
- 03Talk to it, then publish it.
