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Recovery Survey

Please Complete this Survey for Helpful Information About Your Knee Replacement. 

You and your surgeon have decided to treat your osteoarthritis with a DePuy Orthopaedics, Inc. knee replacement. By completing this survey, you will have access to additional information about knee replacement and helpful tips related to your recovery and proper care for your implant. 

If you have already mailed in your form, thank you. Please click here to continue.

* Indicates fields are required
 
  * Would you like to receive additional information?  
    Yes, I Would Like Additional Information
No, Please Don't Contact Me
 
 
  * First Name  
     
 
  * Last Name  
     
 
  * Street Address  
     
 
  * Your City  
     
 
  * Your State  
     
 
  * Your Zip  
     
 
  Email Address  
     
 
  * Date of Surgery  
     
 
  * Date of Birth  
     
 
  * Gender  
    Male   Female    
 
  * Knee Recently Replaced:  
    Right   Left   Both    
 
  * Is this your first knee replacement?  
    Yes   No
 
 
  * Do you have pain in your other knee?  
    Yes   No
 
 
  * Type of knee implant received:  
    Fixed-Bearing   Rotating Platform   Unsure
 
 
  * Name of Surgeon (first & last)  
     
 
  * Your Surgeon's City  
     
 
  * Your Surgeon's State  
     
 
  * Name of Hospital  
     
 
  * City  
     
 
  * State  
     
 
  * Electronic Signature  
     
 
  * Date  
     
 
   

The following information is optional

  
 
  Race/Ethnicity:  
    Caucasian   African American   Hispanic   Asian   Other
 
 
  How was the recovery kit you received helpful?  
     
 
  What recommendation(s) do you have to improve it?  
     
 
  Would you recommend a loved one with knee pain talk to an orthopaedic surgeon to learn
about knee replacement?		  
    Yes   Possibly   No    
 
  Did the information you received prior to surgery adequately prepare you for your surgical
experience?		  
    Yes   Somewhat   No    
 
  Did the information you received prior to surgery adequately prepare you for your physical therapy
program?		  
    Yes   Somewhat   No    
 
       
 
  Your information will be used by DePuy Orthopaedics, Inc. and its affiliates to give you information about total knee replacement recovery. DePuy Orthopaedics, Inc. will not share your information with anyone except as required by law. To review, change or be removed from this contact list, email AskDePuy@dpyus.jnj.com.

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