WOMAC Osteoarthritis Index

Your answers stay on this device until you press Submit. If you press Submit, the completed form is sent over a secure connection and faxed to our office. You can also print the page or save it as a PDF instead.

Patient details

Patient name

Date of birth

Today's date

Joint

Side

Needed if you submit the form to our office.

Think about the joint you chose above. For each question, choose the answer that best describes how you felt in the past 48 hours. Each answer scores 0 (None) to 4 (Extreme).

Your WOMAC scores

Pain0 / 20

Stiffness0 / 8

Physical function0 / 68

Total0 / 96

Lower is better. A higher score means more pain, stiffness or difficulty. The percentage is the total divided by 96.

Part A: Pain

Part B: Stiffness

Stiffness is a feeling of less ease when you move your joint.

Part C: Physical function

This means your ability to move around and look after yourself.

Send your form to our office

When your form is complete, press Submit. It is faxed securely to our office.

All forms

Other forms: Oswestry Disability Index (ODI) · PROMIS Physical Function and Pain Interference

WOMAC 3.1 Index, Likert version. This form is for patients of Garden State Medical Center. It is not a diagnosis or medical advice. Your provider will review your scores with you.