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Michigan neuropathy screening instrument.
| Right foot | Left foot |
| Appearance of feet: deformities, dry skin, callus, infection, fissure | |
| Absence=0 | Absence=0 |
| Presence=1 | Presence=1 |
| Ulceration | |
| Absence=0 | Absence=0 |
| Presence=1 | Presence=1 |
| Achilles tendon reflex | |
| Presence=0 | Presence=0 |
| Present with reinforcement=0.5 | Present with reinforcement=0.5 |
| Absence=1 | Absence=1 |
| Vibration sense on the dorsum of the large toe | |
| Presence=0 | Presence=0 |
| Reduced=0.5 | Reduced=0.5 |
| Absence=1 | Absence=1 |
