2 Minute Neuropathy Assessment Fill out the form below and get your instant results! Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *EmailConfirm EmailDo you know the cause of your neuropathy? *Diabetes/Insulin ResistanceChemotherapy or radiation therapyBlood pressure medicationCholesterol medicationAntibioticsPhysical injury or surgeryOther causeI don't knowWhat symptoms are you experiencing? *TinglingNumbnessPainBurning or coldnessIncreased sensitivity to touchLoss of balance or coordinationCrampsOtherWhere do you feel these sensations? *ToesFeetLegsFingersHandsArmsOtherHow long have you been experiencing symptoms? *Less than 6 months6 months to a year1-3 years3-5 years5-10 years10+ yearsOn a scale of 1-10 how much discomfort are you in? Selected Value: 0 0 being No Pain or discomfort and 10 being Unconscious. Pain makes you pass out.Are your symptoms worse at night? *YesSometimesNoDo you experience loss of balance or coordination issues related to neuropathy? *YesSometimesNoHave you been diagnosed with diabetes, insulin resistance, prediabetes, or blood sugar issues? *YesNoNot sureDo you take blood pressure or cholesterol medications? *YesNo How symptoms? Where How would you describe your diet? *Healthy and balancedMostly healthy with some processed foodAveragePoor (a lot of processed food and sugar)Do you drink alcohol? *NoOccasionallyWeeklyMost daysHow physically active are you? *Very active, regularly exerciseActive most days, exercise occasionallyRegularly active, but don't exerciseNot very active, don't exerciseWhat are you currently doing to address your neuropathy symptoms? *Nothing yetNutritional supplementsMedicationChiropracticAcupunctureRed light therapyCBDOtherAre you looking for a natural solution (not a drug) to your neuropathy symptoms or nerve damage? *YesMaybe, I'd like more information firstNot at this timeWould you be interested in a 1-on-1 consultation with one of our Wellness Consultants? *Yes!Maybe, I'd like more information firstNot at this timeIf yes, please give us your phone number and location (so we don't call in the middle of the night).Submit Take action to nourish and repair your nerves NOW! Get Started Today!
