Questionnaire for your patients to self-report possible symptoms of Long Covid.
Often, people who recover from Covid-19 still experience limitations in their performance that they do not necessarily attribute to the Covid-19 infection.
Therefore, we have designed a questionnaire for checking common Long Covid Symptoms based on our experience. Please note that this questionnaire is not based on scientific results. If you have any feedback, ideas or suggestions for improvement, please feel free to share them via the contact form. We are very interested in continuously developing our knowledge and findings.
Download the Long Covid symptom checker here to take to your doctor.
1) Since Covid-19, I have had problems breathing or a feeling of shortness of breath when exercising
2) Since Covid-19, I have experienced problems climbing stairs and exercising my muscles
3) Since Covid-19, I have experienced persistent coughing
4) Since Covid-19, I have had heart palpitations
5) Since Covid-19, I have felt more tired, lethargic or weak
6) Since Covid-19, I have experienced joint or muscle pain
7) Since Covid-19, I have had problems with my sense of smell or taste
8) Since Covid-19, I have had problems with balance and fine motor skills
9) Since Covid-19, I have experienced problems finding words
10) Since COVID-19, I have had problems concentrating or speaking long sentences
11) Since COVID-19, I have experienced anxiety and sleep disorders
12) Since COVID-19, I have felt listless, disinterested and isolated
13) Since COVID-19, I have had problems controlling my emotions
14) The awful experience of the Covid-19 infection refuses to let go of me