My neurologist did the skin punch biopsy in her office. It's actually a fairly simple procedure, and I think it can be done by your primary care doctor if they are familiar with the procedure. Some insurance companies may balk at paying for it, but my doctor was able to get it approved by Medicare before she did the test.

My fatigue manifests mostly in my inability to stay awake, but my legs get very tired too. Small fiber neuropathy can start with the feet and move up the legs—that's been the pattern my numbness and tingling have followed. My biopsy showed that the small fibers had been destroyed in my ankle and were far fewer in the thigh. The YouTube video I mentioned is helpful in understanding how this happens. One thing I learned is to use the word "fatigue" rather than "weak." When doctors test my resistance (pushing back when they push against my arms/legs) it can be pretty firm, but walking or standing is difficult for me.