Keele STarT Back Score

If you have been advised by the surgery to submit a Keele STarT Back Score assessment please use this form.

Keele STarT Back Score

About You

Please use this date format: DD/MM/YYYY.

Keele STarT Back Screening

Thinking about the last 2 weeks tick your response to the following questions:

This is your total score from all 9 questions
This is your sub score from questions 5-9

Please note that the details you give will be used to update your medical records.