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Slow Twitch COVID-19 Questionnaire
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* Indicates required question
Have you tested positive for COVID-19? If yes, proceed to the following questions
*
Yes
No
Select your gender
Female
Male
Prefer not to say
Other:
Clear selection
When were you diagnosed with COVID-19?
February - April
May - July
August - October
November - current
Clear selection
What is your age demographic?
18 & under
18 - 24
25 - 39
40 - 54
55+
Clear selection
Please select all symptoms that you experienced
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
How long did your symptoms last?
no symptoms
less than 3 days
about a week
1 - 2 weeks
2+ weeks
Clear selection
Did you require hospitalization or ICU?
Admitted to hospital
ICU
Both
Clear selection
Do you feel any long term effects of COVID-19?
Yes
No
Unsure
Clear selection
Have you seen a physician for a follow up?
Yes
No
Do not feel that it is necesarry
Clear selection
Were you prescribed medication for COVID-19 symptoms?
Yes
No
Clear selection
Please list any medication that you were prescribed and took below if applicable
Your answer
Please describe any long term effects of the virus that you are experiencing if applicable
Your answer
Submit
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