Orthopedic Post-Operative Follow-up Form
Patient Name
Date of Birth
Date of Surgery
Type of Surgery
Surgeon
Date of Follow-up
Current Symptoms
Physical Exam Findings
Wound Status
Pain Level
None
Mild
Moderate
Severe
Mobility/Assistive Devices
Medications
Imaging/Tests
Plan/Recommendations
Next Follow-up Date
Clinician Name
Signature