Please select which joint(s)/area(s) you wish to be injected

• Ankle
• Elbow
• Hip
• Knee
• Spine
• Shoulder
• Wrist

Would you consider your current level of disability

• Unbearable
• Severe
• Moderate
• Mild
• None

Have you taken measures recently to reduce your weight if you have a BMI of >30

• Local NHS Clinic
• Local Slimming Club i.e. Weight Watchers
• Own exercise programme i.e. Gym/Swimming/Walking etc
• Have not taken any measures