Neuropathy

Do you ever have legs and/or feet that feel numb? 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? Do you ever have any burning pain in your legs and/or feet? Yes No

Are your feet too sensitive to touch? Are your feet too sensitive to touch? Yes No

Do you get muscle cramps in your legs and/or feet? 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? Do you ever have any prickling or tingling feelings in your legs or feet? Yes No

Does it hurt at night or when the covers touch your skin? Does it hurt at night or when the covers touch your skin? Yes No

When you get into the tub or shower, are you unable to tell the hot water from the cold water with your feet? When you get into the tub or shower, are you unable to tell the hot water from the cold water with your feet? Yes No

Do you ever have any sharp, stabbing, shooting pain in your feet or legs? Do you ever have any sharp, stabbing, shooting pain in your feet or legs? Yes No

Have you experienced an asleep feeling or loss of sensation in your legs or feet? Have you experienced an asleep feeling or loss of sensation in your legs or feet? Yes No

Do you feel weak when you walk? Do you feel weak when you walk? Yes No

Are your symptoms worse at night? Are your symptoms worse at night? Yes No

Do your legs and/or feet hurt when you walk? Do your legs and/or feet hurt when you walk? Yes No

Are you unable to sense your feet when you walk? Are you unable to sense your feet when you walk? Yes No

Is the skin on your feet so dry that it cracks open? 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? Have you ever had electric shock-like pain in your feet or legs? Yes No

Would you like a doctor to contact you? Would you like a doctor to contact you? Yes No

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