Nerve Health Symptom Tracker
Monitoring Changes in Sensation & Comfort
Tracking symptoms helps you and your healthcare provider identify patterns, changes, and treatment effectiveness.
Use this tracker daily or weekly.
Instructions for Patients
✔ Check your feet and hands at the same time each day
✔ Note new or worsening symptoms
✔ Bring this tracker to appointments
Symptom Rating Scale
0 = No symptoms
1–3 = Mild
4–6 = Moderate
7–10 = Severe
Daily Symptom Log
|
Date |
Tingling |
Burning |
Numbness |
Sharp Pain |
Balance Issues |
Dizziness |
Notes |
|
0–10 |
0–10 |
0–10 |
0–10 |
Yes / No |
Yes / No |
||
|
0–10 |
0–10 |
0–10 |
0–10 |
Yes / No |
Yes / No |
||
|
0–10 |
0–10 |
0–10 |
0–10 |
Yes / No |
Yes / No |
Weekly Reflection Questions
✔ Did symptoms improve, worsen, or stay the same?
✔ Are symptoms worse at night?
✔ Do symptoms increase after certain activities?
✔ Are blood sugar levels higher when symptoms are worse?
Patterns can help guide treatment decisions.
Urgent Symptom Checklist
Contact your provider if you notice:
☐ Sudden weakness
☐ Severe new pain
☐ Loss of balance
☐ New dizziness when standing
☐ Wounds you cannot feel
Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
⚠️ Medical Disclaimer
This resource is provided for educational and informational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. The information presented is general in nature and may not apply to every individual or health situation.
Individuals should consult their physician or other qualified healthcare professional for personalized medical advice, diagnosis, or treatment recommendations related to their specific health conditions and should not begin any new exercise program or change their diet or medications without consulting their healthcare professional.
Call 911 if you are experiencing a medical emergency.