Knee Surgeries
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Full Name
Mobile Number
Did the doctor advise you to undergo a knee replacement surgery?
Yes
No
I haven’t visited the doctor
City
When would you like to undergo the surgery?
As soon as possible
within 1–3 months
not sure
Do you have previous X-rays or a CT Scan showing the condition of the joint?
Yes
No
When did you last have an X-ray?
Recently
6 months ago
I don’t remember
Additional Notes
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