Joint Pain Quiz

Please take a few moments to fill out the following form. Your responses will be sent to a member of our Total Joint Center team, who will contact you during business hours. Thank You.

First Name: *

Last Name:

Telephone Number: * (xxx-xxx-xxxx)

Email Address: *

Are you experiencing pain in your Knee, Hip or Groin?

Yes

If yes, which area(s) is affected?

Is the pain limiting or causing you to change your everyday activites?

Yes

Does the pain or discomfort sometimes require medication stronger than Aspirin or Tylenol?

Yes

Is the medication still working?

Yes

Do the symptoms in your affected joint(s) hurt 4 or more days per week?

Yes

Do you have pain climbing or descending the stairs?

Yes

Does pain force you to stop when walking more than two or three blocks?

Yes

Do you ever use walking aids such as a cane or walker to assist you with walking?

Yes

Do you walk with a moderate limp?

Yes

Do you feel pain when you are lying or sitting down?

Yes

Does pain make it difficult to sleep at night?

Yes

Does your knee or hip sometimes give out when you are physically active?

Yes

Please enter this word in the text field below, then click Submit.

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Redmond Regional Medical Center
501 Redmond Road
P.O. Box 107001
Rome, GA 30165-3019
(706) 291-0291
You May Also Visit Us At RedmondHealth.com.