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Effect of COVID-19 Mandates Survey

After 3 years of mandates related the pandemic, we have witnessed first hand a multitude of health complications and concerns arise from patients of every age and
background. The National Institute of health is offering funding for the
research of such health concerns, and to do our part, we have created a survey
 to collect data on the effect on different areas of health due to mandates, masking, vaccines, lifestyle changes, and more. Additionally, we are collecting data on symptoms associated with Long Haulers Syndrome.

All information collected will be kept anonymous and used for research purposes.

NOTE: An E-mail field is required with the Kajabi platform- if you would like to receive future information on statistics, etc. please fill out that field. If you would prefer NOT to share your email, please enter [email protected]. Regardless of sharing e-mail or not, your identity will never be shared.

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Question 1 of 14

Demographics (Gender) 

A

Male

B

Female

Question 2 of 14

Age (when filling out for your child, select their age)

A

0 to 5

B

6 to 10

C

11 to 18

D

19 to 35

E

35 to 50

F

51 to 70

G

71+

Question 3 of 14

Have you had a confirmed case of COVID-19? 

A

Yes

B

No

C

Probable, but never confirmed.

Question 4 of 14

If you have had a confirmed or probable case of COVID-19, do you experience any of the following symptoms currently?

(Select all that apply)
A

Shortness of breath

B

Muscle tension

C

Headaches

D

TMD

E

Tinnitus

F

Ear infections

G

Increased heart rate

H

Fainting

I

Fear

J

Mood changes

K

Insomnia

L

Interupted cognitive performance

M

Fatigue

N

Anxiety

O

Depression

P

Seizures

Q

No, I have not experienced any of these symptoms after a probable or confirmed case of COVID.

R

Not applicable

Question 5 of 14

Do you use a mask for school, employment, church, etc.? 

(Select all that apply)
A

Yes, I am required to.

B

Yes, I choose to.

C

No, I do not use a facial covering.

Question 6 of 14

On average, how many hours per day do you wear a facial covering? 

A

less than 1

B

1 to 4

C

4 to 8

D

8+

Question 7 of 14

During or after using a mask, do you experience any of the following symptoms? 

(Select all that apply)
A

Shortness of breath

B

Muscle tension

C

Headache

D

TMD

E

Tinitus

F

Ear infections

G

Increased heart rate

H

Fainting

I

Fear

J

Mood changes

K

Insomnia

L

Interupted cognitive performance

M

Fatigue

N

Anxiety

O

Depression

P

Seizures

Q

No, I do not experience any of these symptoms during or after using a mask.

R

Not Applicable

Question 8 of 14

How many more vaccines have you received this year than previous years? 

A

0

B

1 to 2

C

3 to 4

D

5+

Question 9 of 14

If you have received one or more vaccines, have you experienced any of the following symptoms after vaccination? 

(Select all that apply)
A

Shortness of breath

B

Muscle tension

C

Headache

D

TMD

E

Tinitus

F

Ear infection

G

Increased heart rate

H

Fainting

I

Fear

J

Mood changes

K

Insomnia

L

Interupted cognitive performance

M

Fatigue

N

Anxiety

O

Depression

P

Seizures

Q

No, I did not experience any of the above symptoms after vaccination.

R

Not Applicable

Question 10 of 14

Have you experienced an increase in anxiety due to any of the following since the beginning of the pandemic? 

(Select all that apply)
A

Politics

B

Finances

C

Mandates

D

Social Activities

E

No, I have not experienced an increase in anxiety due to any of the above.

Question 11 of 14

Have you had an increase in any of the following symptoms since the start of the COVID-19 pandemic directly related to stress?  (If experienced previously, select symptom if frequency or intensity has increased) 

(Select all that apply)
A

Shortness of breath

B

Muscle tension

C

Headaches

D

TMD

E

Tinitus

F

Ear infections

G

Increased heart rate

H

Fainting

I

Mood changes

J

Insomnia

K

Interupted cognitive performance

L

Fatigue

M

Anxiety

N

Depression

O

Seizures

P

I have not experienced any of these symptoms since the start of the COVID-19 pandemic directly related to stress.

Question 12 of 14

Have you lost your job as a result of COVID-19 mandates? 

A

Yes

B

No

C

Unsure/pending

Question 13 of 14

What positive stress management stradegies have you incorporated in your life since the beginning of the COVID-19 pandemic? 

(Select all that apply)
A

Exercise

B

Yoga

C

Involvment in organizations (churches, non-profits, etc.)

D

Meditation and prayer

E

Healthy eating

F

Artistic outlets

G

Chiropractic care

H

Counseling

I

Massage

J

Accupuncture

K

I have not incorporated any new stress management stradegies.

Question 14 of 14

What positive changes have you experienced as a result of the COVID-19 pandemic?

(Select all that apply)
A

Improved relationships

B

Improved education for children (ex. homeschooling, private school, smaller class sizes, etc.)

C

Balance in life

D

Improved physical health

E

Improved mental health

F

Improved stress management stradegies

G

New hobbies

H

Improved satisfaction with employment (new job, increased emotional fulfillment, work from home etc.)

I

Less stress (ex. less activities, etc.)

J

I have not experienced any positive changes in my life as a result of the COVID-19 pandemic.

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