Oswestry Disability Index(ODI) Survey Results: Prior to Surgery

Patient Name

Primary Physician's Name

Today's Date

1. Pain Intensity

2. Personal Care (Washing, Dressing, etc.)

3. Lifting

4. Walking

5. Sitting

6. Standing

7. Sleeping

8. Sex life (if applicable)

9. Social Life

10. Traveling

© Dr. Jeremy Fairbank. The tools listed on this website do not substitute for the informed opinion of a licensed physician or other health care provider. All scores should be re-‐checked. Please see our full Terms of Use.

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Oswestry Disability Index(ODI) Survey Results: Prior to Surgery

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