Joint injection pre-assessment questionnaire

You have been sent this form because you have requested, or been offered, a joint injection.

This questionnaire helps us check whether it is safe and appropriate to book your appointment.

You can use this service if you:

• have been invited to do so by the practice
• are registered at the surgery

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of

Start now

You can also phone us on 01842 828481.