Are you living with SI joint pain?

Are you living with SI joint pain?
Dr. Christopher is now offering an advanced minimally invasive surgical procedure for chronic SI joint pain. She is also participating in a clinical study to evaluate outcomes after this procedure.
Privacy Statement

Thank you for participating in this survey about your SI Joint pain. By submitting this form you agree that study staff may contact you for research purposes or research related programs. Limited study staff will have access to your responses. Your information may be shared with our third party partners SI-BONE, so that they may contact you related to research.
Do you agree to the privacy statement?*

YesNo
Have you been diagnosed by a healthcare provider with sacroiliac joint (SI joint) dysfunction?*

YesNo
How long have you been experiencing SI joint pain?

Less than 6 monthsMore than 6 months
On a scale of 0-10 where 0= no pain and 10= worst pain imaginable, what is your average SI joint pain?*
Does your SI joint pain limit certain activities of daily living, such as walking long distances, sitting or standing for long periods of time, climbing stairs, getting in and out of the car, or turning over in bed?*

YesNo
Have you received non-surgical care for your SI joint pain, such as injections, radiofrequency ablation, or physical therapy?*

YesNo, please contact me to schedule an appointment!
Are you currently seeking worker's compensation or disability benefits for your SI joint or low back pain?*

YesNo
Looking at the image above, where does your pain hurt the most?

Area 1Area 2Area 3Area 4Area 5Area 6
Do you avoid sitting for long periods of time because of the pain?

Yes, sitting hurtsNo, sitting doesn't hurt
Does climbing stairs make the pain worse?

YesNo
Did the pain start during pregnancy or soon after childbirth?

YesNoNever been pregnantThe pain started before pregnancyNot applicable
Does traveling in a vehicle make your back or button pain worse?

YesNo
Is it painful to stand on one leg (affected side) for a prolonged period?

YesNo
Please contact me for an appointment to further evaluate my SI joint pain
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Thank you for your submission. Have a nice day.
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