Knee Health Assessment

2 Gender

Female Male Other

3 Height & Weight *

Used to calculate BMI — helps assess knee load

4 Which knee is affected? *

Left knee Right knee Both knees

5 How long have you had this discomfort? *

Less than 1 month 1–6 months 6–12 months 1–5 years More than 5 yearsOver 5 years / long-term

6 Where exactly is the discomfort? *
Select all that apply

Front of knee (kneecap area)Patellofemoral area Inside of knee (medial side)Medial compartment Outside of knee (lateral side)Lateral compartment Behind the kneePopliteal area Upper knee / thigh areaSuprapatellar Entire knee / all overDiffuse, hard to pinpoint

7 What type of discomfort do you feel? *
Select all that apply

Aching / dull pain Sharp / shooting pain Stiffness Swelling / puffy Clicking / popping Giving way / instability Locking — can't fully bend/straighten Burning / hot sensation Numbness / tingling

8 How bad is the discomfort? *
0 = no pain, 10 = worst imaginable

0 — No pain 10 — Worst pain

9 When is the discomfort worst? *
Select all that apply

Morning after waking up After sitting for a long time Walking on flat ground Walking up/down stairs Standing for long periods At night / in bed After exercise / activity Weather changes (rainy/cold)

10 How much does this affect your daily activities? *

Not at all — I can do everything normally Slightly — I can do everything with some discomfort Moderately — I have difficulty with some activities Severely — I need help with many activities Very severely — I cannot do most daily activities

11 Which activities are difficult?
Select all that apply

Walking more than 15 minutes Climbing stairs Squatting / kneeling Getting up from a chair Putting on shoes / socks Standing up from the floor Getting in/out of car Exercise / sports Sleep — pain wakes me up

12 Previous knee injuries or surgery?

No previous injury or surgery Previous injury — no surgery Previous knee surgery Both injury and surgery

Please describe the injury/surgery:

13 Existing medical conditions
Select all that apply

Osteoarthritis Rheumatoid arthritis Diabetes High blood pressure Osteoporosis Gout None of the above Other

14 Current medications or supplements for your knee?

15 Treatments you've already tried
Select all that apply

No treatment yet Painkillers (paracetamol, NSAIDs) Physiotherapy / exercises Knee brace / support Ice / heat therapy Traditional Chinese medicine Injections (cortisone, hyaluronic acid) Massage / acupressure

16 What is your main concern? *

17 What is your primary goal? *

Pain relief Better mobility for daily activities Return to sports / exercise Prevent further deterioration Understand what's wrong Other

18 How did you hear about us?

Friend / family Doctor referral Social media Internet search Other

19 Anything else you'd like to share?

Knee Health Assessment

🦵 Knee Health Assessment

Assessment Complete!