OmniFlex Clinical Study

If you have your Study ID* Number and would be willing to help us collect clinical data on the effectiveness of OmniFlex in relieving joint pain and stiffness, please enter the Study ID Number below. Thank you for helping us validate the clinical effectiveness of OmniFlex on a large population of users, in a cost-effective manner. As a small token of our appreciation, a coupon code for 50% off our regular price will be provided upon final submission of your study. The coupon code can be applied to your next OmniFlex order.

*If you have purchased OmniFlex, you have already received a Study ID Number with your product shipment. If you misplaced your Study ID Number, please use the Contact Us button to request your Study ID Number, and it will be sent to your Email address.

Please note that you can enter your clinical use data weekly by returning to the study data form, entering your weekly scores, and saving the entries. Alternatively, you can enter all scores for the 8-week period at one time. Also note that you can simplify the data entry process by skipping entries in categories where you are not experiencing pre-treatment symptoms.

Thank you for your participation in this assessment. If you haven't yet used OmniFlex for 8 weeks, fill out what you can, click save, and add more at a later date by entering your unique study ID.

First Name

Last Name

Age

What is your primary Osteoathritis problem? Select One... Hip Knee Other

...Please Specify

How long have you had Osteoathritis? Select One... 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10+ Years

Have you been diagnosed by a physician? Select One.. Yes No

What Medication did you take before starting OmniFlex?

What Medication Do you still Take?

If you haven't yet used OmniFlex for 8 weeks, fill out what you can, click save, and add more at a later date by entering your unique study ID.

Pre-Treatment Score

Date

Pain:

Please rate your pain in your hip and/or knee using the scale below.

Walking Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

Climbing Stairs Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Sleeping Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Resting Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Bearing Weight Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

During & After Excercise Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

Stiffness:

Please rate your stiffness in your hip and/or knee using the scale below.

Morning Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Afternoon Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Night Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

During & After Excercise Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Limitation of Function:

Please rate your limitation of function in your hip and/or knee using the scale below.

Descending Stairs Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Ascending Stairs Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Rising From Sitting Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Standing Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Bending From Floor Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Walking on a Flat Surface Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Getting In/Out of Car Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Shopping Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Putting On/Taking Off Socks Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Rising From Bed Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Lying in Bed Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Sitting Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Getting On/Off the Toilet Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Heavy Domestic Duties Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Light Domestic Duties Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Week 1 Score

Date

Pain:

Please rate your pain in your hip and/or knee using the scale below.

Walking Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

Climbing Stairs Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Sleeping Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Resting Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Bearing Weight Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

During & After Excercise Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

Stiffness:

Please rate your stiffness in your hip and/or knee using the scale below.

Morning Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Afternoon Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Night Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

During & After Excercise Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Limitation of Function:

Please rate your limitation of function in your hip and/or knee using the scale below.

Descending Stairs Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Ascending Stairs Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Rising From Sitting Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Standing Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Bending From Floor Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Walking on a Flat Surface Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Getting In/Out of Car Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Shopping Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Putting On/Taking Off Socks Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Rising From Bed Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Lying in Bed Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Sitting Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Getting On/Off the Toilet Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Heavy Domestic Duties Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Light Domestic Duties Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Week 2 Score

Date

Pain:

Please rate your pain in your hip and/or knee using the scale below.

Walking Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

Climbing Stairs Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Sleeping Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Resting Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Bearing Weight Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

During & After Excercise Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

Stiffness:

Please rate your stiffness in your hip and/or knee using the scale below.

Morning Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Afternoon Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Night Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

During & After Excercise Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Limitation of Function:

Please rate your limitation of function in your hip and/or knee using the scale below.

Descending Stairs Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Ascending Stairs Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Rising From Sitting Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Standing Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Bending From Floor Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Walking on a Flat Surface Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Getting In/Out of Car Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Shopping Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Putting On/Taking Off Socks Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Rising From Bed Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Lying in Bed Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Sitting Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Getting On/Off the Toilet Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Heavy Domestic Duties Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Light Domestic Duties Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Week 3 Score

Date

Pain:

Please rate your pain in your hip and/or knee using the scale below.

Walking Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

Climbing Stairs Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Sleeping Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Resting Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Bearing Weight Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

During & After Excercise Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

Stiffness:

Please rate your stiffness in your hip and/or knee using the scale below.

Morning Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Afternoon Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Night Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

During & After Excercise Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Limitation of Function:

Please rate your limitation of function in your hip and/or knee using the scale below.

Descending Stairs Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Ascending Stairs Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Rising From Sitting Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Standing Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Bending From Floor Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Walking on a Flat Surface Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Getting In/Out of Car Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Shopping Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Putting On/Taking Off Socks Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Rising From Bed Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Lying in Bed Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Sitting Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Getting On/Off the Toilet Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Heavy Domestic Duties Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Light Domestic Duties Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Week 4 Score

Date

Pain:

Please rate your pain in your hip and/or knee using the scale below.

Walking Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

Climbing Stairs Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Sleeping Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Resting Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Bearing Weight Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

During & After Excercise Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

Stiffness:

Please rate your stiffness in your hip and/or knee using the scale below.

Morning Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Afternoon Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Night Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

During & After Excercise Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Limitation of Function:

Please rate your limitation of function in your hip and/or knee using the scale below.

Descending Stairs Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Ascending Stairs Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Rising From Sitting Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Standing Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Bending From Floor Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Walking on a Flat Surface Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Getting In/Out of Car Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Shopping Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Putting On/Taking Off Socks Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Rising From Bed Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Lying in Bed Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Sitting Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Getting On/Off the Toilet Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Heavy Domestic Duties Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Light Domestic Duties Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Week 8 Score

Date

Pain:

Please rate your pain in your hip and/or knee using the scale below.

Walking Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

Climbing Stairs Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Sleeping Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Resting Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

While Bearing Weight Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

During & After Excercise Select One... 0 - No Pain 1 - Slight Pain 2 - Moderate Pain 3 - Severe Pain 4 - Extreme Pain

Stiffness:

Please rate your stiffness in your hip and/or knee using the scale below.

Morning Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Afternoon Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Night Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

During & After Excercise Select One... 0 - No Stiffness 1 - Slight Stiffness 2 - Moderate Stiffness 3 - Severe Stiffness 4 - Extreme Stiffness

Limitation of Function:

Please rate your limitation of function in your hip and/or knee using the scale below.

Descending Stairs Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Ascending Stairs Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Rising From Sitting Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Standing Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Bending From Floor Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Walking on a Flat Surface Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Getting In/Out of Car Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Shopping Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Putting On/Taking Off Socks Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Rising From Bed Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Lying in Bed Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Sitting Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Getting On/Off the Toilet Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Heavy Domestic Duties Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Light Domestic Duties Select One... 0 - No Limitation 1 - Slight Limitation 2 - Moderate Limitation 3 - Severe Limitation 4 - Extreme Limitation

Please feel free to leave any additional comments below. Once you have completed the study you may submit it by clicking the finish study button.

Thank you for taking the time to help us collect data on the effectiveness of OmniFlex in treating joint problems.

As a small token of our appreciation, the coupon code below can be used at checkout for your next OmniFlex order. A savings of 50% off our regular price will be applied to your order.