Please take a few minutes to complete the Subjective Peripheral Neuropathy Screen Questionnaire below to see if you potentially have peripheral neuropathy.
- Do you ever have legs and/or feet that feel numb? Yes | No
- Do you ever have any burning pain in your legs and/or feet? Yes | No
- Are your feet too sensitive to touch? Yes | No
- Do you get muscle cramps in your legs and/or feet? Yes | No
- Do you ever have any prickling or tingling feelings in your legs or feet? Yes | No
- Does it hurt at night when the covers touch your skin? Yes | No
- When you get into the tub or shower, are you able to tell the hot water from the cold water? Yes | No
- Do you ever have any sharp, stabbing, shooting pain in your legs or feet? Yes | No
- Have you experienced an asleep feeling or loss of sensation in your legs or feet? Yes | No
- Do you feel weak when you walk? Yes | No
- Are your symptoms worse at night? Yes | No
- Do your legs and/or feet hurt when you walk? Yes | No
- Are you unable to sense your feet when you walk? Yes | No
- Is the skin on your feet so dry that it cracks open? Yes | No
- Have you ever had electric shock-like pain in your feet or legs? Yes | No
If you answer yes to three or more questions, you may have Peripheral Neuropathy.