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?

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Name