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

Are Your Nerves At Risk?

Fill in your information with the complete and correct information!

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

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

Let us know on a scale from 1-10

Please select what
applies to you.

Where do you experience these sensations

Click on the areas where you
feel the sensations

Clear all

We are generating your final results...

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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)

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.

Do the sensations get worse at night?

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