Long COVID Survey

Help Us Improve Long COVID Treatments

Thank you for taking the time to share your experience with COVID and Long COVID. Your input is incredibly valuable in helping Dr. Teitelbaum provide guidance to help people recover. This short questionnaire is designed to capture your symptoms, challenges, and what has (or hasn’t) worked for you. Your feedback can make a real difference in shaping better approaches to care, and helping others get their lives back. We truly appreciate your input—every response brings us closer to finding better solutions!

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Your Name
How severe were your COVID symptoms?
Did you at some point fully recover from COVID?
How severe were your Long COVID symptoms?
Did you see a medical professional to help your recovery?
Did you try the S.H.I.N.E. Protocol to help your recovery?
Have you recovered from Long COVID

Privacy Disclaimer:

This form is for collecting personal COVID experiences for potential inclusion in books, articles, or other public materials authored by Jacob Teitelbaum, MD. This is not a medical consultation or treatment. By submitting this form, you consent to the use and publication of your provided information. This includes your name, provided we obtain your permission to publicly reveal your name. Please be aware that the information submitted is not stored with special security protections and may be accessible to the public.