GAE Form

Are you between 40 - 80 years old?

Yes No

Do you have moderate to severe knee pain?

Yes No

Have you had an x-ray showing osteoarthritis, but without bony deformity or sclerosis?

Yes No

Are you experiencing tenderness in your knee?

Yes No

Have physical therapy, medications and/or joint injections been unsuccessful?

Yes No

Would you like to avoid surgery or you can’t have surgery?

Yes No