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Angioplasty

Arthritis

Arthroscopic Surgery

Balance Testing and Care

Bariatric Weight-Loss Surgery

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Bio-identical HRT

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Ear, Nose and Throat (ENT)

Early Intervention Program

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Exuberan

Eye Care

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Gestational Diabetes

Gynecologic Oncology

Hand Surgery and Rehabilitation

Healthy Eating

Heart Disease And Pregnancy

High-Risk Pregnancy Care

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Joint Replacement Institute

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Knee Replacement

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Partial Knee Replacement

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Podiatry/Foot and Ankle Surgery

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Prenatal Testing/Genetic Counseling

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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?

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No

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