>

>





Search SIF

 


 
|
|
|
|
 

Find by Body Area
gear1.gif (9873 bytes)

This quick questionnaire leads to an interactive whiplash machine will allow you to find information, exercises, and advice by body area.    

Please take a few seconds to answer some research questions that will help other whiplash patients. Then you will be directed to the interactive "Whiplash Machine"!
 
    1a.  What is your e-mail address?   (We need this data to ensure the research accuracy of this questionnaire.)

           

    1b. Were you injured in a car accident?

         

    1c. Which car accident related problem is the most disabling (prevents you from doing the things you need to or want to do)?

         

 
   2.  What does this car accident related problem prevent you from doing?  (As much as you could before the accident)

    Type a 1, 2, 3 or 4 next to each category to describe what your most disabling problem prevents you from doing:

    1=No car accident related problems with this activity

    2=Some problems, but I can usually do this activity

    3=Significant problems, I avoid this activity

    4=I can't do this activity because of my most disabling car accident problem

    Walking     Running    Climbing Stairs     Lifting or Carrying Groceries

    Reading     Sitting      Standing               Driving

    Bending     Chewing   Sleeping                Looking Right or Left

    Gripping Things

 
    3.  How often do you have problems doing the things you described above?

   

 
   4. Did you have this problem before the car accident?

   

 
    5. How long has it been since the car accident that caused this problem?

   

 
   6. What part of the world did you have your car accident?

    State (USA)    Country (Outside USA Only) 

 
   7.  How did you car get hit?     
Front-Head On Front Quarter Panel-NOT Head On
Driver's Side Passenger's Side
Rear Quarter Panel Rear-end
None of These I was a pedestrian
Other (On bike, motorcycle, etc...)  

 
   8.  How much damage was there to your car?

         

 

(Press Submit with all questions answered to access the interactive whiplash machine...)