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This questionnaire has been designed to give us information as to how your back or leg pain is affecting your ability to manage in everyday life. Please answer by checking ONE box in each section for the statement which best applies to you. We realise you may consider that two or more statements in any one section apply but you will only be able to select one statement - the one which most clearly describes your problem.

10 questions which should take you no more than 5 minutes to complete