Tell Us More About Your Knee

STAK Enquiry

Getting you back to life’s precious moments.

First Name

Last Name

Date of Birth

Email

Gender

Full Address

Post code

Phone

Weight

Height

Knee surgery procedure

Date Of Surgery

Any details you’d like to share following your surgery?

Which Knee?

Left Right

Manipulation under anaesthetic?

Yes No

Currently under physiotherapy?

Yes No

How much can you bend your knee?

How much can you straighten your knee?

Please detail any other treatments?

Medical history

List medications that you take

How did you pay for your surgery?

Private NHS Insurance

Details please

Lifestyle eg working? retired, daily activities

How did you hear about us?

Goals eg in/out car, stairs, riding bike etc

What did you search for on Google that brought you to us?

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