Quiz - STAK Knee Stretcher

Hi there! I believe we haven't met. What's your name?

Great! What's the best email to send your results to?

How old are you?

Phone Number

What is your gender?

Male Female Other

What are your goals?

Are you currently having physio? if yes is it NHS, Private Hospital or Private practice

Have you had surgery?

Yes No

Date of surgery?

Have you had an manipulation under anaesthetic?

Yes No

How swollen is your knee?

Mild Moderate Severe

How painful is your knee?

How often does the knee swell

All the time daily several times a week rarely

how would you describe the pain in your knee?

Mild Moderate Severe

Do you know how much flexion (bend) you currently have?

Do you know how much extension (straightening) you currently have?

Disturbed sleep?

Have you taken painkillers or anti-inflammatories in the past?

do you get pain at night which keeps you awake?

every night occasionally never

which anti inflammatories or pain killers have you taken in the past?

How motivated are you?

How confident are you in completing programme/physio alone?

Do you enjoy group exercise?

Yes No

How motivated are you feeling to complete exercises at the moment?

very alittle not at all

How did you hear about us?

The STAK Orthopaedic Tool is a patented device. STAK is a registered Trademark ® of STAK Orthopaedics Ltd.

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