Follow-Up (Post-Surgery)

 /  / 


Date of surgery:
 /  / 

Surgeon name:

Surgery type:

Compared to right before the surgery is your body part:

Percentage better or worse (0 - 100%):

With pain on a scale of 0 (no pain) to 10 (the worst pain possible), please rate the level of pain for your body part over the last week:

At its least painful:

On average:

At its worst:

Over the last four weeks, are things:

Would you recommend the surgery to a friend with a similar problem?

Give your body part a global grade (0 - 100) where 100 is perfect and 0 is useless (you’d rather cut the part off) over the last few weeks:

Recaptcha Word Verification: