PASC Wrist Scores (SANE-F, SANE-I)
Please enter the date *
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Last Name *
Your answer
First Name *
Your answer
Date of Birth *
MM
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DD
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YYYY
Treating Doctor *
Are you right or left handed?
Which wrist was treated? *
If both wrists were treated please fill out a separate survey for each wrist
What treatment did you have on your wrist? *
If both wrists were treated please fill out a separate survey for each wrist
Shoulder SANE-F Score *
Enter a number for the current functional level of your wrist. 100% is normal function, 0% is completely disabled
Your answer
Shoulder SANE-I Score (% improvement)
Enter a number for the % improvement in your wrist compared to before treatment. 100% is completely better; 0% is no improvement
Your answer
Thank you for completing the Wrist Survey!
Your answer
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