PANDAS & COVID-19 Surveillance Form
This form is only to be completed by parents who have a child with confirmed PANDAS and confirmed or suspected COVID-19
Sign in to Google to save your progress. Learn more
Child's Age
Does your child have a diagnosis of PANDAS
Clear selection
Does your child have a confirmed diagnosis of COVID-19
Clear selection
Did your Child show an increase in PANDAS symptoms following COVID-19 infection
Clear selection
If they did show an increase in symptoms, how long did this last for?
Clear selection
If there was an increase in symptoms, what treatments did you use?
Which treatments did your child improve on?
Clear selection
Did your child experience any side effects to treatment? (Give detail below)
Details of side effects (if applicable)
Other comments
Clear form
Never submit passwords through Google Forms.
This form was created inside of Children's e-Hospital. Report Abuse