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Neuropathy Risk Assessment Questionnaire

The following questions will help you understand whether your Nerve Health is at risk for peripheral neuropathy based on specific risk factors for nerve damage

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Are Your Nerves At Risk?

Fill in your information with the complete and correct information!
Area Code + Phone Number
Are you a Healthcare Professional?
  • Yes
  • No
  • Doctor
  • Pharmacist
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Do you experience any of the following sensations in hands and/or feet?

Choose what applies to you
  • Burning
  • Tingling
  • Electric shock like pain
  • Numbness
  • Pins & needles
  • Other weird / unusual sensation
  • None of the above
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Please select what 
applies to you.

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How bothersome have 
these symptoms overall 
been in the last two weeks?

Let us know on a scale from 1-10

1

10

5

Not at all

Most bothersome

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We are generating your final results...

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Where do you experience these sensations

Click on the areas where you 
feel the sensations

Clear all

Body Selector
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YOUR TOTAL SCORE IS: 
0
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Please talk to your doctor and share the results of this questionnaire.
A total score > 4 (max. score is 14) may indicate peripheral neuropathy.
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Is the distribution of these sensations symmetrical?

(E.g. have you felt these sensations in both feet or in both hands at the same time)
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Do the sensations get worse at night?

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