Is This Neuropathy Approach Right for You?

Neuropathy symptoms can have different causes — and not everyone is a good candidate for the same solutions.

This short survey helps us understand your symptoms and determine whether you may qualify for next steps.

⏱ Takes about 5 minutes • 🔒 Private & confidential

Have You Ever Been Diagnosed With Neuropathy?

Yes

No

Age Group

18 - 24

25 -34

35 - 44

45 -54

55 - 64

65 Older

Rather Not Say

Do you have any of the following symptoms?

(select all that apply)

Tingling or sharp pain in feet or hands

Burning sensation in feet or hands

Loss of sensation or numbness

Difficulty with or loss of balance

Weakness in arms or legs

Cramping, or pain when walking

Are your symptoms (like pain, tingling, and numbness) worse at night?

Yes

No

Are You Having Difficulty With Any Of The Following?

(select all that apply)

Sleeping At Night

Climbing Stairs

Balance

Driving

Exercising

Other

How Long Ago Did You First Suspect There Was A Problem?

Less Than 1 Year

1-2 Years

2-5 Years

5-10 Years

10+ Years

We have treated patients from under 6 months onset to over 40 years of progression

Do You Know What The Causes Are? If So, What?

(select all that apply)

Diabetes Related

Chemotherapy / Cancer Treatment

Vitamin + Nutrition Deficiency

Autoimmune Disorder

Trauma: Accident/Injury

Hereditary

Multiple Causes

Other

Idiopathic/Unknown

I Don't Know

Are you on any drugs for your pain?

Yes

No

Select one:

Gabapentin
Lyrica
Pregabalin
Tramadol
Neurontin
Other
No elements found. Consider changing the search query.
List is empty.

Are you enrolled in Medicaid?

Yes

No

Do you live in The Woodlands, TX or within driving distance?

Yes

No

Congratulations! It Appears As Though You May Be A Candidate For Treatment.

How Motivated Are You Towards Getting Your Symptoms Under Control?

Getting Rid Of These Symptoms Is Very Important For Me Right Now

My Neuropathy Symptoms are NOT A Big Priority For Me Right Now

Full Name *

Phone *

I consent to receive marketing text messages from North Houston Neuropathy (Renew Life Wellness Centers) at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

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Take This Quick Self-Check to See if You Qualify

Tell Us More About Your Condition

Takes 5 minutes

Have You Ever Been Diagnosed With Neuropathy?

Yes

No

Age Group

18 - 24

25 -34

35 - 44

45 -54

55 - 64

65 Older

Rather Not Say

Do you have any of the following symptoms?

(select all that apply)

Tingling or sharp pain in feet or hands

Burning sensation in feet or hands

Loss of sensation or numbness

Difficulty with or loss of balance

Weakness in arms or legs

Cramping, or pain when walking

Are your symptoms (like pain, tingling, and numbness) worse at night?

Yes

No

Are You Having Difficulty With Any Of The Following?

(select all that apply)

Sleeping At Night

Climbing Stairs

Balance

Driving

Exercising

Other

How Long Ago Did You First Suspect There Was A Problem?

Less Than 1 Year

1-2 Years

2-5 Years

5-10 Years

10+ Years

We have treated patients from under 6 months onset to over 40 years of progression

Do You Know What The Causes Are? If So, What?

(select all that apply)

Diabetes Related

Chemotherapy / Cancer Treatment

Vitamin + Nutrition Deficiency

Autoimmune Disorder

Trauma: Accident/Injury

Hereditary

Multiple Causes

Other

Idiopathic/Unknown

I Don't Know

Are you on any drugs for your pain?

Yes

No

Select one:

Gabapentin
Lyrica
Pregabalin
Tramadol
Neurontin
Other
No elements found. Consider changing the search query.
List is empty.

Are you enrolled in Medicaid?

Yes

No

Do you live in The Woodlands, TX or within driving distance?

Yes

No

Congratulations! It Appears As Though You May Be A Candidate For Treatment.

How Motivated Are You Towards Getting Your Symptoms Under Control?

Getting Rid Of These Symptoms Is Very Important For Me Right Now

My Neuropathy Symptoms are NOT A Big Priority For Me Right Now

Full Name *

Phone *

I consent to receive marketing text messages from North Houston Neuropathy (Renew Life Wellness Centers) at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

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