Do your feet or legs hurt during or after work on hard surfaces?
Yes     No

Do you avoid exercise or activities because you know you will be in pain?
Yes     No

Are you overweight?
Yes     No

Do you have Type 1 or Type 2 Diabetes?
Yes     No

Do you have arthritis?
Yes     No

Do you have a family history of foot or leg problems?
Yes     No

Do your heels or the balls of your feet hurt first thing upon rising in the morning or after sitting for a while?
Yes     No

Do you have bunions or do you have a family history of bunions?
Yes     No

Do you have unexplained lower back pain?
Yes     No

Do you pronate (roll in) or supinate (roll out) or wear the heels of your shoes over to one side or the other?
Yes     No