Knee Pain Survey

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

Welcome to Restart Knee

How would you rate the pain in your knee?

Please select the option that best represents the level of pain in your knee.

How much is the knee pain affecting your daily activities?

Please select the option that best represents how your knee pain is affecting your ability to perform daily activities.

How has your knee pain affected you emotionally and mentally? Please share any feelings or thoughts you've experienced due to your knee condition.


On a scale of 1 to 10, how motivated are you to address and manage your knee pain?

Please rate your motivation level on a scale of 1 to 10, where 1 is least motivated and 10 is highly motivated.

What activities do you find most challenging due to your knee pain?

Please list the activities that you find most challenging to perform due to your knee pain.

My main goal before completing my physiotherapy at Restart Knee is to ______________.