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Knee Pain Survey

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

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Welcome to Restart Knee
1

How would you rate the pain in your knee?

Please select the option that best represents the level of pain in your knee.
2

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.
3

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

4

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.
5

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.
6

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

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