Questionnaire Questionairre 1. Have you ever been diagnosed with diabetes?YesNo2. Are your feet cold, blue, swollen, or have you ever been told you have a circulation problem?YesNo3. Do you have feelings of electrical shock, or bugs crawling on your legs? Do you have numb feet or legs?YesNo4. Do you have bumps on the side of your big or little toe?YesNo5. Do you have heel or arch pain first thing in the morning or after you have been resting?YesNo6. Do you have thick, black, yellow, crumbly, or ugly nails?YesNo7. Do you have pain in the balls of your feet?YesNo8. Do you have calloused, scaly, or cracked feet?YesNo9. Do you get ingrown toenails?YesNo10. Do you have sores on your feet that are slow healing?YesNoName* First Last Phone*Email* Any Comments