Peripheral Neuropathy Quiz Step 1 of 5 20% Have you experienced an asleep feeling or loss of sensation in your legs or feet?*NoYesDo you ever experience a prickling or tingling sensation in your legs or feet?*NoYesAre your feet ever overly sensitive to touch?*YesNo Is the skin on your feet so dry that it cracks open?*YesNoDo you ever experience muscle cramps in your legs and/or feet?*YesNoDo you ever feel weak when you walk?*YesNo Do you ever experience a sharp, stabbing, shooting pain in your feet or legs?*YesNoAre your symptoms worse at particular time of the day?*Yes, during the dayNoYes, at nightHave you ever experience an electric shock-like pain in your feet or legs?*NoYes Do your legs and/or feet ever feel numb?*NoYesDo your legs and/or feet hurt when you walk?*NoYesWhen you get into the bathtub or shower, are your feet unable to tell the hot water from the cold water?*YesNo Do your legs and/or feet ever feel numb?*NoYesAt night, in bed, does it hurt when the covers touch your skin?*YesNoAre you unable to sense your feet when you walk?*NoYesEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.