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WOMAC Form

WOMAC

The Western Ontario and McMaster Universities Osteoarthritis Index

MM slash DD slash YYYY
Instructions: Please rate the activities in each category according to the following scale of difficulty. Select the number of "E's" that corresponds with your answer to each question.
0 = None, 1 = Slight, 2 = Moderate, 3 = Very, 4 = Extremely

Pain

Stiffness

Physical Function
______ / 96 = _______%

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ECCO-Medical-600

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Lone Tree, CO
8080 Park Meadows Drive, Suite 150
Lone Tree, CO 80124
(720) 668-8818

Pueblo, CO
323 S. Purcell Blvd. #150
Pueblo, CO 81007
(Please use the side entrance)
(719) 569-3226

Fax: (877) 229-5440
Email: info@eccomedical.com

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