Thank you for taking time to fill out this confidential survey.
This survey will help the doctors I’m working with to learn and continuously fine-tune and further improve this Long Covid protocol.

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* 1. In general, how would you rate your overall health?

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* 2. How severe are your Long Covid symptoms right now and in the past week? 
Being able to “function” means to be able to work, go to school, do household chores, etc.

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* 3. Please check off all the symptoms you currently have:

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* 4. What type of activities are you currently NOT able to do, that you wish you could do?  Check off all that apply:

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* 5. What medications or supplements have you taken so far that has truly helped you feel better? Please list anything you’ve taken so far that has helped:

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* 6. This protocol can take 6 weeks or longer for you to fully heal. Will you have the time and patience to follow through with the complete protocol?

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* 7. Describe in your own words how you currently feel, and what your limitations are.

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* 8. What is your gender?

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* 9. What is your age?

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* 10. We would like to send you a follow-up survey after you complete the Schoch Protocol. Can we have your email address to send that to you in about two months?
Your email address will be used for this survey only.
Your survey results will be confidentially used to help advance the science behind this protocol, and deepen our understanding of Long Covid.

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