General (Non-Shoulder) Patient Evaluation Form
Please answer the following questions as they pertain to your AVERAGE day. If you had a SHOULDER surgery please do not use this form but use the "Shoulder Evaluation Form".
Your Name:
Your E-Mail Address:
What part of the body did Dr. Brady operate on? Choose one... Knee Hip Ankle Hand / Wrist Elbow Foot
On your average day - how is your PAIN now compared to before surgery? Choose one... Much better Somewhat better About the same Somewhat worse Much worse
How is your FUNCTION now compared to before surgery? Choose one... Much better Somewhat better About the same Somewhat worse Much worse
Overall - how is your SATISFACTION with your result? Choose one... Very Satisfied Somewhat Satisfied Neither satisfied or dissatisfied Somewhat Dissatisfied Very Dissatisfied
Was your case a workers compensation case? ...Choose... Yes No
If it was a workers compensation case - has your case been settled? ...Choose... Yes No
