Geniculate Funnel Geniculate Funnel Name Email Address Phone Date of Birth The following questions ask about your feelings and experiences regarding the impact of knee pain and osteoarthritis symptoms on your life. Please consider each question as it relates to your experiences with knee pain during the previous 3 months. There are no right or wrong answers. Please be sure to answer every question by checking the most appropriate box. If the question does not apply to you, please check “none of the time” as your option. Rate your pain when... Walking None Slight Moderate Severe Extreme Climbing stairs None Slight Moderate Severe Extreme Sleeping at night None Slight Moderate Severe Extreme Resting None Slight Moderate Severe Extreme Standing None Slight Moderate Severe Extreme Rate your pain when... Morning None Slight Moderate Severe Extreme Evening None Slight Moderate Severe Extreme Rate your difficulty when... Descending stairs None Slight Moderate Severe Extreme Ascending stairs None Slight Moderate Severe Extreme Rising from sitting None Slight Moderate Severe Extreme Standing None Slight Moderate Severe Extreme Bending to floor None Slight Moderate Severe Extreme Walking on even floor None Slight Moderate Severe Extreme Getting in/out of car None Slight Moderate Severe Extreme Going shopping None Slight Moderate Severe Extreme Putting on socks None Slight Moderate Severe Extreme Rising from bed None Slight Moderate Severe Extreme Taking off socks None Slight Moderate Severe Extreme Lying in bed None Slight Moderate Severe Extreme Getting in/out of bath None Slight Moderate Severe Extreme Sitting None Slight Moderate Severe Extreme Getting on/off toilet None Slight Moderate Severe Extreme Doing light domestic duteis (cooking, dusting) None Slight Moderate Severe Extreme Doing heavy domestic duteis (moving furniture) None Slight Moderate Severe Extreme How did you hear about us? Google Radio Physician referral Friend or family Social Media Total Score 0 Send