Knee Injection Aftercare Form
Please complete this form to help us monitor your recovery following your recent knee injection.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Date of Injection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Which knee was injected?
*
Left Knee
Right Knee
Both Knees
Current pain or swelling in the injected knee?
*
No pain or swelling
Mild
Moderate
Severe
Redness or warmth around the injection site?
*
No
Mild
Significant
Have you experienced fever or any signs of infection (chills, drainage, or increasing pain)?
*
No
Yes
How is your mobility/function since the injection?
*
Normal
Slightly limited
Moderately limited
Severely limited
Are you using any medication or home care for your knee after the injection?
*
No
Yes, medication
Yes, home care (ice, rest, etc.)
Both medication and home care
Please share any additional concerns, questions, or comments regarding your recovery.
Submit Aftercare Form
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