Knee MRI Questionnaire Home > Patient Forms > Knee MRI Questionnaire NameDateReferring PhysicianPlease answer all questions as best as possible1. Please provide a brief history of the pain you are experiencing with your knee(s).2. How did the pain in your knee(s) occur?3. How long have you had this issue with your knee(s)?4. If this pain was not due to injury, was the condition gradual?YesNo5. Is the pain that you are experiencing located at the inner or the outer part of the knee?InnerOuterBoth7. Is the kneecap painful?YesNo6. Is the pain behind the knee?YesNo8. Does the knee lock?YesNo9. Does the knee swell?YesNo10. Do you have prior history of knee surgery?YesNo11. Have there been any other imaging studies of your knee(s)?NoMRICT ScanX-RayWhen and where were the studies perform?12. Are you currently taking any medication? If yes, what are you taking?Submit