Rheumatoid arthritis review

Thank you for completing this form. A clinician will review your answers and get in touch if needed.

Are you able to get in/out of bed unaided?

Are you able to get in/out of a chair unaided?

Are you able to dress unaided?

Are you able to climb stairs unaided?

Are you able to use the toilet unaided?

Do you have any problems walking?

Height (inches/cm)

Weight (stone/kg)

Blood pressure (if you have a home blood pressure machine)

Smoking statusDo you smoke (cigarettes, cigars and vaping). If yes, then how many a day. If you quit, tell us how many you used to smoke and when you quit.

Is there anything else you would like to tell us about your rheumatoid arthritis?

On a scale of 1-10 (with 10 being the most painful), how would you rate your pain?

When did you last have a flare-up of your arthritis?

Do you have any tender joints at present?

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