I am sorry to bother you with questions after surgery but I need your assistance.

This is important for several reasons:

1. To continue to prove that your treatment is necessary and worthwhile to insurance providers,
2. To document my results to share with the worldwide orthopaedic community and establish higher standards of care,
3. To solicit feedback from you, the patient, about your experience so that we can continuously improve to provide the highest quality of care.

Please select which body part where you are having surgery.

On a scale of 0 to 100, please select a number to rate the function of your injured body part at this time with 100 being normal.

And last, on a scale of 0 to 10, please please select a number to rate the pain of your injured body part at this time with zero representing “No pain” and ten representing the “worst pain you’ve ever felt or could imagine.”

Thank you again for your help and I appreciate your participation.