Post-COVID Questionnaire

This form is designed to review your symptoms post-COVID, and compare your health prior to testing positive.

Client Details

Pre-COVID

Pre-COVID, how would you rate the following aspects of your health.

0 - of no concern at all

10 - severely impacting health and quality of life

Your COVID Symptoms

Post-COVID

Post-COVID, how would you rate the following aspects of your health.

0 - of no concern at all

10 - severely impacting health and quality of life