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Knee Replacement Surgery
Hip Replacement Surgery
Sports Knee Injuries & Reconstruction
Arthroscopic (“Keyhole”) Knee Surgery
Revision Knee & Hip Surgery
Knee Replacement Surgery
Hip Replacement Surgery
Sports Knee Injuries & Reconstruction
Arthroscopic (“Keyhole”) Knee Surgery
Revision Knee & Hip Surgery
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Patient Registration Form
Osteoarthritis Form
Injury Form
Patient Registration Form
Osteoarthritis Form
Injury Form
Contact Us
Home
About Me
Expertise
Knee Replacement Surgery
Hip Replacement Surgery
Sports Knee Injuries & Reconstruction
Arthroscopic (“Keyhole”) Knee Surgery
Revision Knee & Hip Surgery
Clinic Info
Your First Appointment
Types of Patients
Telehealth Consultations
Fees & Cancellations
For Referrers
FAQs
Online Patient Registration Form
Contact Us
Home
About Me
Expertise
Knee Replacement Surgery
Hip Replacement Surgery
Sports Knee Injuries & Reconstruction
Arthroscopic (“Keyhole”) Knee Surgery
Revision Knee & Hip Surgery
Clinic Info
Your First Appointment
Types of Patients
Telehealth Consultations
Fees & Cancellations
For Referrers
FAQs
Online Patient Registration Form
Contact Us
Injury Form
Please complete the following patient registration before your visit, to make the process on the day as simple as possible.
Injury Form
Your Details
First Name
*
Surname
*
Email
*
Phone
What do you do for work?
*
What sport do you like to play (if any)?
*
About the Injury
What happened in the injury – how did it occur?
*
Did you hear a pop or crack?
*
After the injury
Was there swelling?
How quickly did the swelling come up?
Could you walk?
*
Yes
No
Did you need crutches? (If so, for how long?)
*
Was there restricted range of motion of the joint (bending and straightening)?
*
Where was the pain exactly? Does it go anywhere else?
Has the pain changed or gone away?
*
Yes
No
What makes it worse (eg: walking, standing, stairs, getting up and down from chairs, cars pivoting, squatting)?
Does the joint click or make a noise?
*
Yes
No
Is the clicking/noise new?
*
Yes
No
Is the clicking/noise painful?
Yes
No
Does the joint lock (get stuck)?
*
Yes
No
How long does this locking last for?
Does the joint still swell up?
*
Yes
No
What makes this happen?
Does the joint give way underneath you (collapse)?
*
Yes
No
Does this happen when
Walking in a straight line?
Doing stairs?
Twisting on the knee while walking?
Twisting on the knee playing sport?
Do you get pain at night?
*
Yes
No
Does it cause you to wake or have difficulty getting to sleep?
*
Yes
No
What pain killers do you take and how often?
Have you ever had an injury or surgery to that joint?
*
Yes
No
Any other treatment?
Any other joint pain?
Any other medical problems?
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