Neuropathy Questionnaire | Sound Pain Solutions

1. Do you ever have legs and/or feet that feel numb?

Yes
No

2. Do you ever have any burning pain in your legs and/or feet?

Yes
No

3. Are your feet too sensitive to touch?

Yes
No

4. Do you get muscle cramps in your legs and/or feet?

Yes
No

5. Do you ever have any prickling or tingling feelings in your legs or feet?

Yes
No

6. Does it hurt at night or when the covers touch your skin?

Yes
No

7. 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

8. Do you ever have any sharp, stabbing, shooting pain in your feet or legs?

Yes
No

9. Have you experienced an asleep feeling or loss of sensation in your legs or feet?

Yes
No

10. Do you feel weak when you walk?

Yes
No

11. Are your symptoms worse at night?

Yes
No

12. Do your legs and/or feet hurt when you walk?

Yes
No

13. Are you unable to sense your feet when you walk?

Yes
No

14. Is the skin on your feet so dry that it cracks open?

Yes
No

15. Have you ever had electric shock-like pain in your feet or legs?

Yes
No

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

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