Welcome to the Hip Assessment

There are numerous factors associated with the development of hip pain and mobility disorders. This Hip Assessment will take less than 5 minutes to complete. At the end, our team receives your score and will reach out if a hip consultation with our provider is the next best step for you.

  • How would you describe the pain you usually have in your hip?*

  • Have you been troubled by pain from your hip in bed at night?*

  • Have you had any sudden, severe pain (shooting, stabbing, or spasms) from your affected hip?*

  • Have you been limping when walking because of your hip?*

  • For how long have you been able to walk before the pain in your hip becomes severe (with or without a walking aid)?*

  • Have you been able to climb a flight of stairs?*

  • Have you been able to put on a pair of socks, stockings or tights?*

  • After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your hip?*

  • Have you had any trouble getting in and out of a car or using public transportation because of your hip?*

  • Have you had any trouble with washing and drying yourself (all over) because of your hip?*

  • Could you do the household shopping on your own?*

  • How much has pain from your hip interfered with your usual work, including housework?*

  • Patient Information

    If you are a strong candidate for knee surgery, our office will contact you.

  • Please enter your first name.
  • Please enter your last name.
  • Please enter your height.
  • Please enter your height.
  • Please enter your weight.
  • Please make a selection.
  • Please make a selection.
  • Please make a selection.
  • Please make a selection.
  • Please enter your birthday.
  • Please enter your email address.
    This isn't a valid email address.
  • This isn't a valid phone number.
    Please enter your phone number.
    You entered an invalid number.
  • Please enter your city.
  • Please select your state.
  • * Required fields. By providing your details, you agree to receive communications such as annual appointment reminders, health education materials, event information, etc. from Adventist Health. For more information, you can read our legal and privacy policies in the footer below.
Personal Information

Congratulations!

You've completed the Hip Quiz.

Now, enter your contact information so we can send your score.