Shoulder OA Study

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Yes

First Name *

Last Name *

Phone Number *

Date of Birth MM/DD/YYYY *

Zip Code or Postal Code *

Are you Male or Female? *

Have you been experiencing osteoarthritis in one of your shoulders for at least 3 months? *

How many days per month do you experience pain in your shoulder due to osteoarthritis? *

Do you experience persistent pain in BOTH shoulders due to a diagnosed medical condition? *

Do you have any surgical hardware in your shoulder? *

Surgical hardware includes plates, pins or screws.

Have you been diagnosed (by a doctor) with any other medical conditions? *
(For example: rheumatoid arthritis, gout, lupus, inflammatory bowel disease, asthma, depression, psychiatric illness, COPD).
Please list here or write 'none'.
Please only include conditions which have been diagnosed by a doctor.

Have you been diagnosed (by a doctor) with any other chronic pain conditions? *

Chronic pain lasts for over three months and may come and go. It can happen anywhere in your body. This is separate from the pain you experience from your shoulder osteoarthritis.

Are you still experiencing pain from this chronic pain condition? *

Are you taking any medications for your shoulder osteoarthritis or other health conditions? *
Please list them below or type ‘none’.

Please, select your height from the dropdown below. *

How much do you weigh in Lbs (pounds)? *

Which racial or ethnic group(s) do you identify with? *
Please select all that apply.

American Indian or Alaskan Native

Asian

Black or African American

Hispanic Latino or Spanish

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Another race or ethnicity

I prefer not to answer

What is the best day/time to reach you via telephone (we know you are busy)? *