Have you been diagnosed with diabetes?

Do you experience tingling, numbness, or burning in your hands or feet?

*

Yes, often

Occasionally

No

How long have you had diabetes (or symptoms)?

*

Do your feet feel numb or fall asleep even when you’re not sitting awkwardly?

*

Yes

No

Would you be open to learning about new treatment options or research studies?

Would you be open to learning about new treatment options or research studies? *

Yes

Occasionally

No

Rate your foot/leg discomfort in the past 7 days:

*

You're almost done! Share your contact details to see if you qualify.

First Name *

Last Name *

Phone *

Email *

Postal code *

By clicking ‘SUBMIT SURVEY’, I agree to the terms of the Privacy Policy and acknowledge that I will receive communications via phone, email or text regarding my health and health risks.