Outcome Centre
Post Op

What is a score form?

Fields in red are required.
Name:
Date of Birth:
Hospital Number (if known):
Address:
Telephone:
Email Address
Postcode:

Consultant
  
Operation Date
  
Side
  
Implant
  
     

Pain (Right Hip)

 

Pain (Left Hip)

 
Walking
  
Limp
  
Distance
  
Stairs/Steps
  
Sitting  
Transport  
Movement (Right Hip)  
Movement (Left Hip)
  
Satisfaction  
Your Scores    
Right Hip  
Left Hip  
Satisfaction  

Have you had any problems since having the operation?
Are there any comments you wish to make?
If you want to sent this form to us now, click 'Submit your score!'
If you would rather print these details and send them to us, click
'Print this form'

 

If you decide to print your form please sent it to:

The Oswestry Outcome Centre
Institute of Orthopaedics
Oswestry
SY10 7AG