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Request More Info on Spinal Coard Stimulation
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Name
*
First
Last
Email
*
Phone Number
*
What symptoms are you experiencing?
Burning pain in the feet or legs
Tingling or “pins and needles”
Numbness in the feet or legs
Sharp, shooting, or electric-like pain
Pain that is worse at night
Difficulty walking or completing daily activities
Select all that apply
How long have you had these symptoms?
Less than 3 months
3–6 months
6–12 months
More than 1 year
for tried treatments
Are your symptoms making it difficult to sleep, walk, work, or complete daily activities?
Yes
No
Sometimes
Have you been diagnosed with diabetic peripheral neuropathy or diabetic nerve pain?
Yes
No
Not sure
Have you had any testing to evaluate your nerve symptoms?
EMG / nerve conduction study
Foot exam or neuropathy screening
Bloodwork related to diabetes or neuropathy
MRI of the lower back
I have not had testing
Not sure
Select all that apply
Have you tried medications or other treatments for nerve pain?
Yes
No
Not sure
Submit