This questionnaire has been designed to provide information on how much pain you experience on a day-to-day basis following your trauma.

Please answer every section below and for each category, please indicate the severity of the symptom using the 1-10 point scale where

1 = No Symptoms

10 = Extreme Symptoms

Please read this Disclaimer of Liability, then click on one of the following statements to proceed with the online self-assessment:

• I have read and understand the disclaimer, and I agree to hold www.whiplashcentre.com and De Nardis Enterprises Pty Ltd its contractors, subcontractors, agents, servants and employees harmless from and against any and all claims, actions, damages, liability and/or expenses in connection with damage arising from or out of my voluntary election to continue viewing and/or using the whiplashcentre program/web-site. I also confirm that I have discussed the use of this site in detail with my treating physician and that I have obtained his/her approval to proceed.

• I do not understand, or do not agree with the disclaimer.