Joint Pain Questionnaire

Please take a few moments to complete the following Joint Pain Questionnaire. A representative will contact you to discuss your results and schedule an appointment if you would be interested in a thorough evaluation of your joint pain.
* Denotes required fields
* Do you have generalized pain in and around your knee or hip?
* Is the pain limiting movement or stopping you from doing sports or other activities you once enjoyed?
* Do you have pain when going up or down stairs?
* Do you ever use walking aids such as a cane to assist you with walking?
* Do you feel pain with extended sitting?
* Does your knee or hip sometimes give out when you are physically active?
* Do you experience shoulder pain after typical activities such as getting dressed?
* Have any of your close relatives had arthritis of the knee or chronic knee pain?

Contact Us

For more information about our orthopedic services, please contact:

Patti Said

© 2014 Genesis Health System - All rights reserved.

1227 E. Rusholme Street Davenport, IA 52803 563-421-1000