• You and your knees
  • Your fitness level
  • Previous treatments
  • Your treatment goals

How long have you been experiencing knee pain?

Have you been diagnosed with osteoarthritis of the knee(s)?

How would you describe your level of knee pain?

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How satisfied are you with your ability to exercise?

How would you rate your level of knee pain during the following activities?

  • (1 = Least Pain, 5 = Most Pain)

    • 1
    • 2
    • 3
    • 4
    • 5
  • Activity

  • Sitting

  • Standing

  • Walking

  • Going up and down stairs

  • At night resting in bed

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Which osteoarthritis treatments have you tried?
(select all that apply)

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Osteoarthritis of the knee can limit your ability to participate in your usual daily activities, such as going to work, getting around, taking care of chores or running errands, and getting out with your friends or family.

What are the most important activities you’d like to get back to:

Include any other notes or questions you’d like to include on your report:

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Summary

  • How long have you been experiencing knee pain?

    Your answer:

  • Have you been diagnosed with osteoarthritis of the knee(s)?

    Your answer:

  • How would you describe your level of knee pain?

    Your answer:

  • How satisfied are you with your ability to exercise?

    Your answer:

  • How would you rate your level of knee pain during the following activities?

    Your answer:

    • Activity:

    • Sitting:

    • Standing:

    • Walking:

    • Going up and down stairs:

    • At night resting in bed:

  • Which osteoarthritis treatments have you tried?
    (select all that apply)

    Your answer:

  • What are the most important activities you’d like to get back to:

    Your answer:

  • Include any other notes or questions you’d like to include on your report:

    Your answer:

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Synvisc-One®

Synvisc-One is a treatment to decrease pain and discomfort associated with osteoarthritis that replaces the diseased synovial fluid in your knee with a gel-like substance that is very similar to the synovial fluid found in healthy, young joints.


For Canadian residents only.

Last updated: 12/16/2014
Copyright © 2022 sanofi-aventis Canada Inc. All rights reserved.
Synvisc is a registered trademark of Genzyme Corporation.