COVID-19 Rebound Symptom Tracker Form
COVID-19 Rebound Symptom Tracker Form. Please use this form to track possible rebound symptoms after a recent COVID-19 infection. All fields are focused on symptom tracking and operational use.
Date symptoms restarted
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of initial COVID-19 positive test or diagnosis
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current rebound symptoms (select all that apply)
*
Fever
Cough
Shortness of breath
Fatigue
Loss of taste or smell
Headache
Sore throat
Muscle or body aches
Other
How severe are your current symptoms?
*
Mild
1
2
3
4
5
6
7
8
9
Severe
10
1 is Mild, 10 is Severe
Are your symptoms improving, worsening, or unchanged?
*
Improving
Worsening
Unchanged
Have you had a fever (temperature above 100.4°F/38°C) since symptoms restarted?
*
Yes
No
Not sure
Current temperature (if measured, in °F or °C)
Current oxygen level (if measured, % SpO2)
Have you recently used any COVID-19 treatment or medication?
*
Yes
No
Have you contacted a healthcare provider about your rebound symptoms?
*
Yes
No
Submit
Should be Empty: