The Knee Way Patient Questions

Patient name:

Please list your current:
Height:
Weight:
Age:

1. When did the pain in your knee start?

Few days ago
Months ago
Years ago

2. My knee pain is best described as:

A recent injury from a sporting event
A long-standing or recurring pain

3. Has the pain in your knee affected you emotionally?

Yes
No
Sometimes

4. How much do you exercise?

Weekly
Monthly
Not Often

5. Are you a member of a Gym or Fitness Center?

6. How would you describe your eating habits?

Great
Good
Poor

7. Have you been prescribed a Knee Brace in the past year for your pain?

8. Will you be willing to follow a Physical Therapy treatment path?

I can commit to 1 time a week
I can commit to 1 time a week
I can not commit to therapy

9. Are you willing to consider innovative treatments even if they are not covered by your insurance?

10. Have you previously received knee injections by a Physician?

11. Will you be willing to track your Knee Health weekly on your smartphone?

I would be willing to track my health for 3 months.
I would be willing to track my health for 6 months.
I am not willing to track my health

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About us

The mission of USA Knee Centers is to develop state-of-the-art Medical Clinics to provide patients with quality education and treatment options in all operative and non-operative therapies for pain associated with the aging knee. We are dedicated to providing a better patient experience through new technologies, therapies and protocols to enhance patient care....

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