Choice PT: Staying Active & Becoming Better Balanced

TAKE THE BACK SCREEN!

Circle “YES” or “NO” For Each Statement Below

My back pain has spread down my leg(s) at some time in the last 4 weeks

YES 1

NO 0

I have had pain in the shoulder or neck at some time in the last 4 weeks

YES 1

NO 0

YES 1

NO 0

I have only walked short distances because of my back pain

In the last 4 weeks, I have dressed more slowly than usual because of back pain

YES 1

NO 0

It’s not really safe for a person with a condition like mine to be physically active

YES 1

NO 0

Worrying thoughts have been going through my mind a lot of the time

YES 1

NO 0

I feel that my back pain is terrible and it’s never going to get any better

YES 1

NO 0

YES 1

NO 0

In general I have not enjoyed all the things I used to enjoy

www.choiceptny.com

Add up the number of points for each “yes” answer.

#Choose2GiveBack

Spreading Holiday Cheer!!

Both clinics partnered with Hope 7 to help provide a local family with gifts and goodies for the holidays! Thank you to everyone who participated for all your generosity!

Gratefully,

Erin

www.choiceptny.com

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