Please Complete this questionnaire to help our team monitor your post-operative progress.

This questionnaire asks for your views about the amount of pain, stiffness, and disability you have experienced during the last 48 hours. If you are unsure about how to answer a question, please give the best answer you can. If the question does not apply to you, please substitute a similar activity/motion and provide an answer to the question. As a reminder, all questions must be complete in order to calculate a result. You will receive a personalized reply from the Total Joint Program Director.


Required fields are marked with an asterisk *.
Please select your procedure type
At what level do you want your pain to remain before requesting pain medicine
Potential post-operative complication(s) after any surgery, including total joint replacement surgery, are (check all that apply):
To prevent potential side effects of pain medication, such as constipation, your diet should include
Before getting out of bed, it is essential to
The first time you are expected to get up out of bed with the physical therapist is
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