Quiz

Am I doing everything I can to daily help my neuropathy?

• I drink coffee *

  Yes   No   Only decaffeinated

• I take whole food vitamins for my neuropathy? *

  Yes   I don’t take vitamins for this condition   I take B vitamins from my local pharmacy

• I drink alcohol *

  Yes   Yes, but maybe once a week   Very rarely   I don’t drink alcohol

• I know the cause of my neuropathy *

  Yes   No   Unknown Cause

• The cause is no longer present in my life *

  Yes   No

• I drink a lot of tea *

  Yes, more than once a day   Once a day   Minimal amount weekly   No

• I love soft drinks and drink a lot of them? *

  No   Drink it with sugar   Drink it without sugar   Drink Caffeine free   Once a day   Rarely

• I smoke *

  Several cigarettes daily   Once a day   Rarely   I don't smoke

• I eat a lot of carbs *

  Only in vegetables   Yes   No

• I am taking medications for neuropathy *

  Yes   No   antidepressants

• I’m taking blood pressure medication *

  Yes   No

• I’m taking cholesterol medication *

  Yes   No

• I’m diabetic *

  Yes   No   I help it naturally without medication   I take medication

• My diet has processed foods? *

  A lot   Rarely   Natural foods nothing from a box or package

• I have sugar in my diet *

  Yes   Rarely   Never

• I use artificial sweeteners *

  Yes   No

• MSG in my food *

  I avoid it   I don't care   I don’t know all the names that is used for MSG on the labels

• I have stress in my life (physical or mental) *

  No   Some   A lot of stress   I take medication for stress

• First Name *

• Last Name *

• Email Address *