Joint Assessment

* All fields are required
Yes No 1. Have you experienced any injury or previous surgery to a hip, knee or shoulder?
Yes No 2. Has a doctor ever told you that you have arthritis?
Yes No 3. Do your joints swell after prolonged activities?
Yes No 4. Does joint pain continue while resting, day or night?
Yes No 5. Do you find yourself restricting grooming habits or recreational activities due to pain in your hips, knees or shoulders?
Yes No 6. Do you get limited relief or unpleasant side effects from pain medications or supplements for cartilage health?
Yes No 7. Have more conservative treatments like cortisone shots, supportive aids or physical therapy discontinued to relieve pain?
Yes No 8. Do you need the support of a cane or walker because of decreased balance?
Yes No 9. Do you experience a sense that your joint will “give way”?
Yes No 10.Do you need the support of a railing when using stairs, getting out of a chair or up from the floor due to instability or pain?
Yes No 11. Does your joint pain or restrictions in physical activity make you feel anxious, helpless or depressed?