Could You Have Restless Leg Syndrome?

Question 1 of 11

What is your gender?

AMale
BFemale
AMale
BFemale
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Question 1 of 11
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Question 2 of 11

What is your age group?

AUnder 18
B19 to 34
C35 to 44
D45 to 54
E55 to 64
FOver 65
AUnder 18
B19 to 34
C35 to 44
D45 to 54
E55 to 64
FOver 65
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Question 2 of 11
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Question 3 of 11

Do you often experience a strong urge to move your legs?

AYes
BNo
AYes
BNo
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Question 3 of 11
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Question 4 of 11

Is the urge to move your legs accompanied by uncomfortable sensations such as tingling, aching, crawling, or itchiness that will not go away when scratched?

AYes
BNo
AYes
BNo
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Question 4 of 11
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Question 5 of 11

Are you more likely to experience an urge to move your legs or feel the uncomfortable sensations previously described when inactive?

AYes
BNo
AYes
BNo
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Question 5 of 11
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Question 6 of 11

When are symptoms typically worse?

AIn the morning
BIn the afternoon
CIn the evening and night
AIn the morning
BIn the afternoon
CIn the evening and night
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Question 6 of 11
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Question 7 of 11

Does moving your legs offer some temporary relief?

AYes
BNo
AYes
BNo
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Question 7 of 11
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Question 8 of 11

Do you find it difficult to fall asleep at night?

AYes
BNo
AYes
BNo
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Question 8 of 11
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Question 9 of 11

Are you experiencing any of the following medical issues?

ADiabetes
BKidney disease
CDepression
DAnemia
ENone of the above
ADiabetes
BKidney disease
CDepression
DAnemia
ENone of the above
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Question 9 of 11
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Question 10 of 11

Have you undergone a joint replacement or experienced a bone fracture?

AYes
BNo
AYes
BNo
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Question 10 of 11
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Question 11 of 11

Are you taking any of the following medications?

AAntinausea drugs, such as metoclopramide (Reglan) or prochlorperazine (Compro)
BAntipsychotic drugs such as haloperidol (Haldol)
CSelective serotonin reuptake inhibitors (SSRIs), such as fluoxetine(Prozac)
DAntihistamines, such as diphenhydramine (Benadryl)
ENone of the above
AAntinausea drugs, such as metoclopramide (Reglan) or prochlorperazine (Compro)
BAntipsychotic drugs such as haloperidol (Haldol)
CSelective serotonin reuptake inhibitors (SSRIs), such as fluoxetine(Prozac)
DAntihistamines, such as diphenhydramine (Benadryl)
ENone of the above
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Question 11 of 11
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