PASC Foot/Ankle Scores (SANE/KOOS)
Please enter the date *
MM
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DD
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YYYY
Last Name *
Your answer
First Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Treating Doctor *
Which foot/ankle was treated? *
If both knees were treated please fill out a separate survey for each knee.
Where you treated with PRP or Stem Cells or both? *
Ankle SANE-F Score *
Enter a number for the current functional level of your foot/ankle. 100% is normal function, 0% is completely disabled
Your answer
Ankle SANE-I Score
Enter a number for the % improvement in your foot/ankle compared to before treatment. 100% is completely better, 0% is no improvement
Your answer
Thank you for completing the Ankle Survey!
Your answer
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