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Post-COVID Symptom Questionnaire

I am a survivor of COVID-19… would I benefit from physical therapy?

This brief questionnaire will help you understand if physical therapy would help you overcome any lingering effects of
COVID-19, clinically known as Post-Acute COVID Syndrome (PACS).
1. 
Have you tested positive for COVID-19?

2. 
Have any of your COVID-19 symptoms lasted longer than 30 days?

3. 
Are you currently experiencing lingering effects such as joint pain, muscle weakness, or unsteadiness while walking?

4. 
Are your symptoms limiting you in returning back to work or to your daily or recreational activities?

5. 
Are you currently experiencing lingering effects such as joint pain, muscle weakness or unsteadiness while walking?

Send me my results to my email:
Name

Get Started with MOTION

Ready to Start Physical Therapy?

If you have a referral for therapy or have had therapy before and are ready to make an appointment at one of our MOTION clinics, click here to request an appointment and we will contact you to schedule an initial evaluation with an appropriate therapist as soon as possible.

Request an Appointment

Not Sure if PT Can Help?

If you are not sure if or how physical therapy can help you, click here to request a 15-minute phone call with a licensed physical or hand therapist to discuss your clinical issue. They can help you determine if therapy is right for you, before you request an appointment.

Request a Screening from a Therapist