ThePain.net knee pain symptoms/complaints form
When you're going to the doctor´s appointment, you can fill out this form and send it to your own email. From there you can print it out as a reminder for your visit, or if your doctor accepts e-mail, forward it to her/him before the reception. You can also print a blank form and fill it by hand. This may help you to remember better the essential information. Your doctor may get a clearer picture and more time to examine and think about your problems. The form or any other material on this site is not intended to substitute professional medical advice, diagnosis, or treatment.
The sections marked with the star must be filled so that the form can be sent.
  • Write here the time you had first knee pain.
  • Write here the last time you knee pain got worse. If none, leave it empty.
  • Write here the date of the trauma of your knee and describe its character. If none, leave it empty.
  • Write here the character of your knee pain. For instance sharp, dull, burning, throbbing etc.
  • Write here your estimate of the intensity of your knee pain on a scale o 0-10. (0=no pain - 10=worse pain ever)
  • Write here the duration of the previous episodes of your knee pain. If none, leave it empty.
  • Choose the best option or write it in the free space.
  • Choose the best option or write it in the free space.
  • Write here what makes your knee pain worse.
  • Write here what makes your knee pain better.
  • Choose the best option.
  • Choose the best option.
  • If your knee was operated, write here the time of the surgery and its type. If none, leave it empty.
  • If you had a fracture or a serious truma, write here the time of the trauma and its type. If none, leave it empty.
  • If you had radiating pain write it here. Choose the best option or write it in the free space.
  • If you have numbness or tingling write it here. Choose the best option or write it in the free space.
  • Write here if you have pains in other areas. If none, leave it empty.
  • Write here if you have limited movement in the knee. You can write more than one. If none, leave it empty.
  • Write here if you have additional symptoms. You can write more than one. If none, leave it empty.
  • Write here the last medicine you have used for your knee pain. Write its name, stregth and number of doses you have taken in a day.
  • Write here the medicine(s) you have used previously for your knee pain. Write the name, stregth and number of doses you have taken in a day.
  • Write here the medicines you use for other diseases. Write their names, stregth and number of doses you take in a day. If none, leave it empty.
  • Write here the herbal supplements you use. Write their names, stregth and number of doses you take in a day. If none, leave it empty.
  • Write here the other diseases you have. If none, leave it empty.
  • Write here the addional information you want your doctor to know and you think has an impact on your problems.
  • Write here the most important thing about which you want information or the position of your doctor during your visit. For example, diagnosis, rehabilitation possibilities, the need for surgery, what kind of side effect the treatments might have, the need for a sick leave and so on.
  • Write here the second most important thing about which you want information or the position of your doctor during your visit.
  • Write here the additional important things about which you want information or the position of your doctor during your visit. Please take into account that the doctor usually has limited time for the reception.