Neuropathy Risk Assessment Questionnaire
The following questions will help you understand whether your Nerve Health could be at risk based on certain risk factors for nerve damage.
In case you have a concern or would like to get a medical diagnosis, please seek advice from your doctor. This is not a self-diagnosis tool and will not provide a definitive diagnosis.
Before we start, tell us more about you!
Please consider, that is not a self-diagnosis tool and will not replace a medical examination. The test outcome is intended to provide an idea on a potential risk for nerve damage. To receive a precise diagnosis please see your doctor for a medical examination. |
YOUR LIFESTYLE
Are you on a vegetarian diet?
Please consider, that is not a self-diagnosis tool and will not replace a medical examination. The test outcome is intended to provide an idea on a potential risk for nerve damage. To receive a precise diagnosis please see your doctor for a medical examination. |
YOUR LIFESTYLE
Do you exercise on a regular basis?
(3x or more in a week)
Please consider, that is not a self-diagnosis tool and will not replace a medical examination. The test outcome is intended to provide an idea on a potential risk for nerve damage. To receive a precise diagnosis please see your doctor for a medical examination. |
YOUR LIFESTYLE
Do you smoke?
Please consider, that is not a self-diagnosis tool and will not replace a medical examination. The test outcome is intended to provide an idea on a potential risk for nerve damage. To receive a precise diagnosis please see your doctor for a medical examination. |
BACKGROUND
Is there anyone in your immediate family who has been diagnosed with diabetes?
Please consider, that is not a self-diagnosis tool and will not replace a medical examination. The test outcome is intended to provide an idea on a potential risk for nerve damage. To receive a precise diagnosis please see your doctor for a medical examination. |
HOW OBSERVANT ARE YOU?
Do you ever feel one of the following sensations in your hands and feet?
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HOW OBSERVANT ARE YOU?
When it comes to these sensations, I feel them on both hands or both feet at the same time.
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HOW OBSERVANT ARE YOU?
How long have you been experiencing these sensations?
Please consider, that is not a self-diagnosis tool and will not replace a medical examination. The test outcome is intended to provide an idea on a potential risk for nerve damage. To receive a precise diagnosis please see your doctor for a medical examination. |
HOW OBSERVANT ARE YOU?
Is the sensation worse at night?
Please consider, that is not a self-diagnosis tool and will not replace a medical examination. The test outcome is intended to provide an idea on a potential risk for nerve damage. To receive a precise diagnosis please see your doctor for a medical examination. |
HOW OBSERVANT ARE YOU?
Do you take painkillers for these sensations?
Please consider, that is not a self-diagnosis tool and will not replace a medical examination. The test outcome is intended to provide an idea on a potential risk for nerve damage. To receive a precise diagnosis please see your doctor for a medical examination. |
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Please consider, that is not a self-diagnosis tool and will not replace a medical examination. The test outcome is intended to provide an idea on a potential risk for nerve damage. To receive a precise diagnosis please see your doctor for a medical examination.