Questionnaire

1. Have you ever been diagnosed with diabetes?
- Yes
- No
2. Are your feet cold, blue, swollen, or have you ever been told you have a circulation problem?
- Yes
- No
3. Do you have feelings of electrical shock, or bugs crawling on your legs? Do you have numb feet or legs?
- Yes
- No
4. Do you have bumps on the side of your big or little toe?
- Yes
- No
5. Do you have heel or arch pain first thing in the morning or after you have been resting?
- Yes
- No
6. Do you have thick, black, yellow, crumbly, or ugly nails?
- Yes
- No
7. Do you have pain in the balls of your feet?
- Yes
- No
8. Do you have calloused, scaly, or cracked feet?
- Yes
- No
9. Do you get ingrown toenails?
- Yes
- No
10. Do you have sores on your feet that are slow healing?
- Yes
- No
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