Do you have any numbness?

☐ Yes ☐ No

Do you have any tingling sensation?

☐ Yes ☐ No

Do you have any abnormal sensations?

☐ Yes ☐ No

Do you have any pain?

☐ Yes ☐ No

Do you have any weakness?

☐ Yes ☐ No

Persistence of symptoms after 6 wks.

☐ Yes ☐ No

Neurology referral done

☐ Yes ☐ No

If yes, findings?