The RANE Center :: Quality of Life Online Quiz
First Name:
Last Name:
Date of Birth:
Today's Date: 02/19/2019
Are you a new patient? Yes No
Side of Leg Problem:
Surgery Date (if applicable):
How much pain do you feel in your legs?

For the last four weeks:

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 142
How often do your leg problems disturb your sleep?

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 142
How often do your leg problems disturb your morning?

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 142
Do your legs bother you at work?

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 142
Do your legs bother you while standing?

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 142
Do your legs bother you while climbing?

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 142
Do your legs bother you while crouching/kneeling?

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 142
Do your legs bother you while walking briskly?

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 142
Do your legs bother you while traveling by car, bus, or plane?

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 142
Do your legs bother you while doing housework (cleaning, chores)?

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 142
Do your legs bother you during social functions (parties, weddings)?

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 142
Do your legs bother you while playing sports/strenuous activity?

For the last four weeks:

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 160
My legs make me feel on-edge.

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 160
My legs make me become tired easily.

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 160
My legs make me feel I am a burden to people.

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 160
I must always take precautions such as stretching my legs or avoiding standing for a long time.

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 160
I am embarrassed to show my legs.

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 160
My legs make me get irritated easily.

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 160
My legs make me feel handicapped.

Warning: Parameter 2 to __mkrow() expected to be a reference, value given in /loc/web/virtuals/theranecenter.com/app/templates_c/54601fdd93b0592b511946974bb4dbb50e4df8f3_0.file.qol.tpl.php on line 160
I do not feel like going out.