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Watton Medical Practice NHS GP Surgery in South Norfolk

Hip/knee score assessment

Hip/Knee Score Assessment

Section

Confirmation *

I confirm I have added the most up to date phone number

If you are using a UK mobile number, please use the format 07xxxxxxxxx

Please specify the joint affected: *

Hip

Knee

Please specify which area is affected: *

Left

Right

Please complete the following:

How bad is your hip/knee pain? *

None

Mild (occasional pain with longer walks)

Moderate (pain with most activity and walking)

Severe (constant pain – little relief and/or giving way)

How bad is your night pain? *

None

Mild (occasional pain with longer walks)

Moderate (pain with most activity and walking)

Severe (constant pain – little relief and/or giving way)

How far can you walk? *

Unlimited

½ to 1 mile

¼ to ½ mile

Less than ¼ mile

How often do you need painkillers? *

Occasionally

Regularly

Is your pain getting worse? *

Yes

Are you prepared to consider major joint replacement surgery? *

Yes

Are you a carer? *

Yes

Do you rely on a carer? *

Yes

I confirm that the information provided is accurate to the best of my knowledge

If you are human, leave this field blank.

24 Gregor Shanks Way
Watton
Thetford
IP25 6FA

Get directions

01953 881247

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