Were you rear-ended?  This questionnaire is a self diagnostic exercise that may help explain your symptoms...

Only answer these research questions if you were in a rear-end accident...        

1a. Were you involved in a rear-end accident?

Click Here Yes, I was hit from the rear No, I was hit from the front No, I was hit from the side Other

1b.  What is your e-mail address?   (We need this data to ensure the research accuracy of this questionnaire.)

2. How did your car get hit?

       Can't remember or none of these...

3. What was the position of your head at the time of the rear impact?

Click Here Head turned right... Head turned left... Looking straight ahead... Other position... Don't remember...

4.  How severe has your neck pain been this last week?

Click Here Severe Moderate Mild

5.  Right now, when you bring your head back to look up at the ceiling, which position hurts the most?

Click Here Straight back... Head back and bent to right... Head back and bent to left...

Where does it hurt when you bring your head back?

Click Here In the front of my neck on the right In the front of my neck on the left In the back of my neck on the right In the back of my neck on the left

6.  How long has it been since the accident you described above?

Clich Here 0-6 weeks 6-12 weeks 3 months to 2 years 2-10 years 10-20 years 20+ years

7.  Did you have neck pain before this rear-end accident?

Click Here No Yes, I had very mild pain only a few times a year Yes, I had significant neck pain Yes, I had neck pain and was in treatment

8.  Where do you have your auto insurance?

If in USA, enter the 2 letter state postal code  

If outside USA, enter the three letter postal code

9.  How much damage was there to your car?

Click Here 0-$500 500-$1,500 $1,500-$2,500 $2,500-$5,000 More Than $5,000

  The answers will display when you press submit...