Facebook-f Google Linkedin-in Yelp
Book Appointment

Neuropathy Questionnaire

+1 818-835-9517
book appointment

1. Do you ever have legs and/or feet that feel numb?
2. Do you ever have any burning pain in your legs and/or feet?
3. Are your feet too sensitive to touch?
4. Do you get muscle cramps in your legs and/or feet?
5. Do you ever have any prickling or tingling feelings in your legs or feet?
6. Does it hurt at night or when the covers touch your skin?
7. When you get into the tub or shower, are you unable to tell the hot water from the cold water with your feet?
8. Do you ever have any sharp, stabbing, shooting pain in your feet or legs?
9. Have you experienced an asleep feeling or loss of sensation in your legs or feet?
10. Do you feel weak when you walk?
11. Are your symptoms worse at night?
12. Do your legs and/or feet hurt when you walk?
13. Are you unable to sense your feet when you walk?
14. Is the skin on your feet so dry that it cracks open?
15. Have you ever had electric shock-like pain in your feet or legs?

If you have answered “Yes” to multiple questions, then you may be a good candidate for treatment. Contact SoCal Medical Center to schedule your consultation and find the relief you’ve been searching for!

Name
Address
Would you like a doctor to contact you?
Consent