Self Assessment

Did you know that more than 20% of patients with diabetes develop foot complications? Take our interactive 1 minute quiz to assess your risk for diabetic foot disease.

SPACE FOR ILLUSTRATION

QUESTION 1
Do you have dry or cracked skin on your feet?
01 / 13
QUESTION 2
Are you concerned with the health of your toenails?
02 / 13
QUESTION 3
Do you have difficulty caring for your toenails?
03 / 13
QUESTION 4
Do you experience pain involving your feet?
04 / 13
QUESTION 5
Do your feet ever feel numb?
05 / 13
QUESTION 6
Do you have a sensation of pins & needles in your feet?
06 / 13
QUESTION 7
Are your feet constantly cold?
07 / 13
QUESTION 8
Do you have a foot deformity related to diabetes, or have you beendiagnosed with Charcot’s foot?
08 / 13
QUESTION 9
Have you noticed discolouration or redness involving your feet?
09 / 13
QUESTION 10
Do you currently have a non-healing foot wound?
10 / 13
QUESTION 11
Have you ever had a diabetic foot wound/infection?
11 / 13
QUESTION 12
Have you had a toe/foot/leg amputation for a diabeticwound/infection?
12 / 13
QUESTION 13
Provide a contact method we can reach you at?
13 / 13

Assessment Submitted

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