Diabetic Nerve Pain Assessment

Diabetic Nerve Pain Assessment

It can be hard to explain how you are feeling to your doctor. This Diabetic Nerve Pain Assessment can help you get the conversation started. You and your doctor can use it to see if you have diabetic nerve pain and how it is affecting you.

Fill it out and take it with you to your next doctor’s appointment.

    Questions
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
1

2

Select all that apply.

3

4

5

6

0 being
"My pain never bothers me when
I am falling asleep and never wakes me up" and

10 being
"I can hardly sleep at all."

7

8

0 being
"My pain never impacts my work" and

10 being
"I am unable to work at all."

9

Select all that apply.

10

Select all that apply.

Diabetic Nerve Pain Assessment

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