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1) Roughly How many hours per day do you sit in a chair?
2-4 hours4-6 hours6-8 hours8-10 hours10-12 hoursOver 12 hours

2) Where do you primarily experience the pain that you have noticed is associated with prolonged sitting
NeckHeadachesMiddle BackLower BackShouldersWristHipsOther

3) Have you seen any other providers for this complaint?
Medical DoctorPhysical TherapistChiropractorMassage TherapistAcupuncturistPhysiotherapistOther

4) Does your pain radiate anywhere?
Up the head (headaches)Down the armBoth armsDown the legOne legBoth legs

5) Do you currently have to take the medication in order to deal with the pain caused by sitting at a desk?
YesNo

6) How many years have you experienced pain due to desk-related activities?
Less than 1 year1-2 years3-4 years4-5 yearsOver 5 years

7) During the day how often do you get up from sitting positions?
1-2x2-3x3-4xOver 4x

8) Do you currently have a sit to stand desk?
YesNo

9) Do you currently take medication for desk related pain?
YesNo