Hip Pain & Function Questionnaire, Department of Orthopaedic Surgery in the Medical School at the University of Minnesota

This questionnaire allows us to assess the outcome of the surgery you have undergone or will undergo.  A part of this questionnaire needs to be filled in by your orthopaedic surgeon.  Preferably you should visit the Orthopaedic Clinic clinic for a scheduled follow-up with Dr. Cheng.  If you cannot, kindly print out this questionnaire, fill it out through Page 4, and mail it to:

Edward Y. Cheng, M.D.
c/o Nancy Borgstrom
University of Minnesota
Department of Orthopaedic Surgery
2450 Riverside Avenue South, Suite R200
Minneapolis  MN  55454
U.S.A.

Download the Questionnaire File

This is a small Acrobat (.PDF) file.  If you need to obtain the Acrobat Reader, please click  on the button to jump to Adobe's web site:

   Get the Acrobat reader from Adobes Web site.

©2002 Regents of the University of Minnesota. All rights reserved.

The University of Minnesota is an equal opportunity educator and employer.

Last modified on Friday Nov 02, 2007

This page is located at http://www.med.umn.edu//ortho/divisions/adult_reconstruction/hip_pain_and_fn_quest.html