Your Knee Pain Assessment Tool
A personalized report for your next doctor appointment
Welcome to Your Knee Pain Assessment Tool

We've made it easy to prepare for your next doctor's visit. Complete our short Knee Pain Assessment and you'll receive a personalized report that will help you discuss your knee pain with your doctor and identify the best treatment options. lt should only take about five minutes to complete. To protect your privacy, we will not save any of your information, so be sure to finish the questionnaire once you start.


Step 1:
Experience Knee Pain
How long have you experienced knee pain?
Step 2:
Knee Pain History
Have you been diagnosed with osteoarthritis of the knee?
When were you diagnosed?
How would you describe your level of knee pain?
In the past three months, has your level of knee pain changed?
Step 3:
Level of Knee Pain
Have you recently had an injury to your knee?

Please briefly describe your injury
(255 char. max.)

How would you rate your level of knee pain during the following activities?
1- Least Pain, 5 - Most Pain
Activities 1Least Pain 2 3 4 5Most Pain  
Sitting
Standing
Walking
Going up and down stairs
At night resting in bed
Step 4:
Exercise Program
Are you able to exercise with your current level of knee pain?


Which types of exercises? Select all that apply.
Please briefly list other exercises (40 char. max.)
Step 5:
Treatment History
Which knee pain treatments have you tried? Select all that apply.



  • *Tylenol is a registered trademark of McNeil Consumer & Specialty Pharmaceuticals, a Division of McNeil-PPC, Inc.
  • † Advil is a registered trademark of Wyeth Consumer Healthcare
  • ‡ Celebrex is a registered trademark of Pfizer, Inc.
Step 6:
Pain Management Goals
Knee pain can limit your ability to do things, like your job, leisure activities or everyday tasks. What are the most important activities you'd like to get back to?
(255 char. max.)

Write in any other notes or questions you'd like included on your report.
(255 char. max.)
Step 7:
Get Your Knee Pain Assessment
Print
Print your Knee Pain Assessment
Email Knee Pain Assessment
Emailing the assessment is a great way to save your personal report on your own computer. You can print it out at a later date to share the information with your doctor.

Please enter a valid email address.
Please make sure the email address values you entered match.
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The information you enter above will not be saved or stored by Sanofi Biosurgery.
The data you provide will only be used to provide you with a personalized printout that you can share with your doctor.

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