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POST COVID RESEARCH REPORTING FORM

This questionnaire was developed in an effort to collect information regarding the profile of patients who have suffered from Covid-19 infection. This information will also be part of a research project undertaken by the Biokinetics Association of Namibia to investigate the effect of physical activity on recovery from Covid-19 and the severity of illness amongst Namibians. Your cooperation and consent is appreciated. All information in this research project is treated as confidential.

By continuing this submission you agree to anonymously submit medical details.

Please be honest in order for the research to reflect true results

Please select your Date of Birth.

DOB

Please specify your gender

Please select your Date of Birth.

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Please enter how many days you were sick.

Days

Please indicate if you where hospitalized or not.

Please select your Date of Birth.

Please indicate if you where vaccinated or not.

Please indicate if you where vaccinated or not.

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Please indicate if other family members in your house were sick or not.

Please indicate if other family members in your house were sick or not.

Please indicate if you where vaccinated or not.

Days

Please indicate if you exercise regularly or not.

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Please indicate your training intensity.

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