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For Health Care Professionals
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Have you previously been diagnosed with diabetes?

What type of diabetes do you have?

How long have you experienced shooting, burning, pins and needles pain from diabetic neuropathy?

On an average day, how would you rate the shooting, burning, pins and needles pain related to your diabetic neuropathy?

No Pain

0
1
2
3
4
5
6
7
8
9
10

Worst Pain Imaginable

No Pain

Worst Pain Imaginable

Over the past six months, how often does your painful diabetic neuropathy impact your life or work activities, or sleep?

Where is your painful diabetic neuropathy located?

(Select all that apply)

Please select one or more answers Next

Which of the following treatments have you ever tried to help manage your painful diabetic neuropathy symptoms?

(Select all that apply, past and current)

Please select one or more answers
Next

Which health care professional is currently helping to manage your pain?

Are you satisfied with your current treatment?

Please select your primary type of health insurance:

I answered these questions on behalf of:

HF10 is approved for the treatment of chronic intractable pain of the trunk and/or limbs. Only a physician can recommend a specific treatment option.

Thank you.

Unfortunately it's unclear at this time whether you are an appropriate candidate for HFX.


- If you have painful diabetic neuropathy, but are not satisfied with the level of relief from prescription medications, or the side effects are negatively impacting your quality of life, then you may want to talk to your primary care physician about alternative treatment options.


- If have another kind of neuropathy, or chronic nerve pain of the trunk (including back, hip, and pelvis) and limbs, then you may want to visit NevroHFX.com to learn about how HFX can help those pain conditions.

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Your pain condition appears similar to other patients being treated with HFXTM for PDN.

Please find a summary of your answers below

Pain score is:

8/10

Struggling with chronic pain for:

Over 3 months

Pain is located in:

Legs, Buttocks, Arms

I’ve already tried:

Epidural Injections, Back Surgery, Nerve Ablations

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  • Please use my information to provide me with phone, email, or text message communications about Nevro products and therapies (including product education and marketing materials), opportunities to participate in Nevro led research panels, and quantitative surveys. I understand that I can choose to participate or decline to participate in any marketing panel. I understand that I can opt-out of further advertising and/or marketing research communications from Nevro by clicking unsubscribe in the email or providing a detailed request to [email protected]

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