Outcome Centre

What is a score form?

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

Consultant
  
Operation Date
  
Side
  
     

Pain (Left Knee)

 

Pain (Right Knee)

 
Walking Distance  
Walking Quality  
Stairs/Steps  
Transfer  
Limp  
Standing  
Sitting  
Swelling  
Stability/Range of motion  
Satisfaction  
Your Scores    
Right Knee  
Left Knee  
     

Do you have any other physical limitations that effect your well being?
Have you had any complications since the operation?
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