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Adolescent Gynecology

Allergy and Immunology - Pediatric

Angioplasty

Arthritis

Arthroscopic Surgery

Balance Testing and Care

Bariatric Weight-Loss Surgery

Behavioral and Mental Health

Behavioral Health - Pediatric (CASTLE)

Bio-identical HRT

Bladder Cancer

Brain and Spine

Brain Surgery

Breast Cancer

Breast Health and Mammograms

Breast Reconstruction

Breastfeeding

Cancer Genetic Counseling and Testing

Cancer Support Services

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Cardiac Rehabilitation

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CASTLE

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CHOP at Virtua

Clinical Trials

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Concussion/ImPACT Testing

Cosmetic Plastic Surgery

Critical Care - Pediatric (PICU)

Dentistry

Depression and Pregnancy

Dermatology

Diabetes Care

Diagnostic Imaging - Pediatric

Diet and Wellness Coaching

Ear, Nose and Throat (ENT)

Early Intervention Program

Emergency Medical Services

Emergency Medicine

Emergency Services - Pediatric

EMS Continuing Education

Endocrinology - Pediatric

Exuberan

Eye Care

Family Medicine

Female Pelvic Health

Fitness

Gastroenterology

Gastroenterology - Pediatric

Geriatric Care Management

Gestational Diabetes

Gynecologic Oncology

Hand Surgery and Rehabilitation

Healthy Eating

Heart Disease And Pregnancy

High-Risk Pregnancy Care

Hip Preservation

Hip Replacement

Home Health Care

Hospice Care

Hyperbaric Oxygen Therapy

Immunotherapy

Infertility

Internal Medicine

Joint Replacement Institute

Kidney Cancer

Knee Replacement

Lab Services

LifeCare

Long-Term Care and Rehabilitation

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Mobile Intensive Care Unit

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Orthopedics

Orthopedics - Pediatric

Otolaryngology - Pediatric

Ovarian Cancer

Pain Management

Palliative Medicine

Partial Knee Replacement

Pathology

Pediatric Services

Personal Health Navigator

Physical Therapy and Rehabilitation

Podiatry/Foot and Ankle Surgery

Post-Acute Care

Pregnancy and Infant Loss Support

Prenatal Testing/Genetic Counseling

Primary Care

Prostate Cancer

Psychiatry

Pulmonary Medicine

Pulmonology - Pediatric

Quad-Sparing Knee Replacement

Radiation Oncology

Radiology Imaging

Robotic Surgery

Seniors Health

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Shoulder Arthroscopy

Skin Cancer

Skin Care and Massage

Sleep Lab - Pediatric

Sleep Medicine

Spa Services

Spine Surgery

Sports Medicine

Sports Medicine Kids

Stroke

Surgery

Surgery and Anesthesia - Pediatric

Teleneurology

Testicular Cancer

Thoracic Surgery

Thyroid Cancer

Type 1 Diabetes

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Urgent Care

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Joint Replacement Questionnaire

Are you a candidate for Joint Replacement Surgery? Please take a few moments to fill out the following online form. Thank you. Read our Privacy Statement.

Are you experiencing pain in your knee, hip or groin?

Yes

No

Is pain limiting your activities or has it caused you to change your everyday routine?

Yes

No

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

Yes

No

Has medication stopped working?

Yes

No

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

Yes

No

Do you have pain climbing or descending the stairs?

Yes

No

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

Yes

No

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

Yes

No

Do you walk with a moderate limp?

Yes

No

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

Yes

No

Does pain make it difficult to sleep at night?

Yes

No

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

Yes

No

Do you have trouble putting on your shoes and socks?

Yes

No

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