• Take the Quiz and Find Out if Our Minimally Invasive Joint Procedure Can Help You

  • Format: (000) 000-0000.
  • Date of Birth **
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  • The following questions ask about your feelings and experiences regarding the impact of knee pain and osteoarthritis symptoms on your life. Please consider each question as it relates to your experiences with knee pain during the previous 3 months. There are no right or wrong answers. Please be sure to answer every question by checking the most appropriate box. If the question does not apply to you, please check “none of the time” as your option.

  • Rate your pain when...

  • Walking*
  • Climbing stairs*
  • Sleeping at night*
  • Resting*
  • Standing*

  • Rate your stiffness in the...

  • Morning*
  • Evening*

  • Rate your difficulty when...

  • Descending stairs*
  • Ascending stairs*
  • Rising from sitting*
  • Standing*
  • Bending to floor*
  • Walking on even floor*
  • Getting in/​out of car*
  • Going shopping*
  • Putting on socks*
  • Rising from bed*
  • Taking off socks*
  • Lying in bed*
  • Getting in/​out of bath*
  • Sitting*
  • Getting on/​off toilet*
  • Doing light domestic duties (cooking, dusting)*
  • Doing heavy domestic duties (moving furniture)*

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