Outcome Centre

What is a score form?

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

Pain (Left Knee)

 

Pain (Right Knee)

 
Walking Distance  
Walking Quality  
Stairs/Steps  
Transfer  
Limp  
Standing  
Sitting  
Swelling  
Stability/Range of motion  
Patient Specific Factors
  
In order to tailor the knee surgery to your specific goal, please rate the importance of each of the following problems
Pain  
Ability to walk  
Ability to bend  
Your Scores    
Right Knee  
Left Knee  
     
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
Shropshire
SY10 7AG