Patient-Rated Elbow Evaluation (PREE) Questionnaire
Please complete this questionnaire to help us assess your elbow pain and functional abilities. Your responses will assist in your care and treatment planning.
Patient Full Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Contact Email Address
example@example.com
Which elbow is affected?
*
Left
Right
Both
How would you rate your elbow pain on average in the past week?
*
No pain
0
1
2
3
4
5
6
7
8
9
Worst imaginable pain
10
0 is No pain, 10 is Worst imaginable pain
How often have you experienced elbow pain in the past week?
*
Never
Occasionally
Frequently
Constantly
Please indicate the level of difficulty you have experienced in the past week performing the following activities due to your elbow.
*
Rows
No difficulty
Mild difficulty
Moderate difficulty
Severe difficulty
Unable to do
Turning a doorknob
1
2
3
4
5
Carrying a grocery bag
6
7
8
9
10
Personal hygiene (e.g., combing hair, brushing teeth)
11
12
13
14
15
Lifting an object overhead
16
17
18
19
20
Writing or typing
21
22
23
24
25
How much has elbow pain interfered with your daily activities in the past week?
*
Not at all
0
1
2
3
4
5
6
7
8
9
Completely unable
10
0 is Not at all, 10 is Completely unable
Do you experience stiffness in your elbow in the morning?
*
No stiffness
Stiffness less than 30 minutes
Stiffness more than 30 minutes
Please rate your satisfaction with your current elbow function.
*
1
2
3
4
5
Please add any additional comments or concerns about your elbow.
Submit Evaluation
Should be Empty: