Patient Forms

For your convenience, here are some forms that you will be asked to complete at the time of your evaluation. To save time, you may print these out, complete at your leisure, and bring them in for the appointment. If there are any questions that you don’t understand, please leave them blank and we will go over them together.

If you are from a long distance and would like to know if you are a candidate for surgery, please fill out the Intake, WOMAC, SF-12, UCLA, and Harris Forms, and send them to us for review. We will also require a recent x-ray of your hip/knee to determine your candidacy.

 Cover Sheet

 Intake Form




 Blank Page

 Harris Resurfacing


You will need the Adobe Reader to view and print these documents.Get Adobe Reader