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1. Check the Long Haul COVID Symptoms that Apply to You. Then Quantify them On a Scale of 1 – 10* 1. Check the Long Haul COVID Symptoms that Apply to You. Then Quantify them On a Scale of 1 – 10* Brain Fog Headache Sleep problems Fatigue Short of breath Metabolism Visual problems (eye issues) Palpitations Joint Pain Muscle aches Dizziness when you stand up (lightheadedness) Feeling sick, loss of appetite, stomach aches, diarrhea Pins-and-needles feelings Tinnitus, earaches Change in smell or taste Headache, fever, sore throat, cough Depression or anxiety Rashes

Brain Fog Brain Fog 1 2 3 4 5 6 7 8 9 10

Headache Headache 1 2 3 4 5 6 7 8 9 10

Sleep Problems Sleep Problems 1 2 3 4 5 6 7 8 9 10

Fatigue Fatigue 1 2 3 4 5 6 7 8 9 10

Short of Breath Short of Breath 1 2 3 4 5 6 7 8 9 10

Metabolism Metabolism 1 2 3 4 5 6 7 8 9 10

Visual Problems (Eye issues) Visual Problems (Eye issues) 1 2 3 4 5 6 7 8 9 10

Palpitations Palpitations 1 2 3 4 5 6 7 8 9 10

Joint Pain Joint Pain 1 2 3 4 5 6 7 8 9 10

Muscle Aches Muscle Aches 1 2 3 4 5 6 7 8 9 10

Dizziness When You Stand Up (lightheadedness) Dizziness When You Stand Up (lightheadedness) 1 2 3 4 5 6 7 8 9 10

Feeling Sick, Loss of Appetite, Stomach Aches, Diarrhea Feeling Sick, Loss of Appetite, Stomach Aches, Diarrhea 1 2 3 4 5 6 7 8 9 10

Pins and Needles Feelings Pins and Needles Feelings 1 2 3 4 5 6 7 8 9 10

Tinnitus, Earaches Tinnitus, Earaches 1 2 3 4 5 6 7 8 9 10

Change in Smell or Taste Change in Smell or Taste 1 2 3 4 5 6 7 8 9 10

Headache, Fever, Sore Throat, Cough Headache, Fever, Sore Throat, Cough 1 2 3 4 5 6 7 8 9 10

Depression or Anxiety Depression or Anxiety 1 2 3 4 5 6 7 8 9 10

Rashes Rashes 1 2 3 4 5 6 7 8 9 10

2. For How Many Months Have You Been Experiencing Long Haul COVID? 2. For How Many Months Have You Been Experiencing Long Haul COVID?1234567+

3. What is Your Biggest Fear/Frustration with Long Haul COVID?

4. What Treatments Have You Tried So Far for Long COVID? 4. What Treatments Have You Tried So Far for Long COVID? Ivermectin NSAIDS Prednisone Metformin Other

5. What Nutritional Supplements Have You Taken for Long COVID? 5. What Nutritional Supplements Have You Taken for Long COVID? Vitamin C Vitamin D3 Magnesium Pro-Biotics Other

6. Because of all the implications and nuances of Long Haul COVID – Do You See the Imperative of Choosing a Comprehensive Metabolic Approach to Managing Your Long COVID? 6. Because of all the implications and nuances of Long Haul COVID – Do You See the Imperative of Choosing a Comprehensive Metabolic Approach to Managing Your Long COVID? Yes No

7. Because of all the implications and nuances of Long Haul COVID, Do You See the Importance of Supporting Your Immune System, Restoring the Damaged Mitochondria, and Cleansing your System? 7. Because of all the implications and nuances of Long Haul COVID, Do You See the Importance of Supporting Your Immune System, Restoring the Damaged Mitochondria, and Cleansing your System? Yes No