COVID-19 Sentinel Memory Community Research Please enable JavaScript in your browser to complete this form.DateFirst Occurrence Date: Approximate Date You Developed a Problem with Your MemoryCharacterize Your Memory LossMinorComes & GoesDisruptiveMajorHow Did it OnsetSuddenlyGradually Over TimeDays After COVID RecoveryWeeks After COVID RecoveryMonths After COVID RecoveryWith COVID-19Please tell us how your Problems with Memory beganTrouble Keeping Track of Time?YesNoFeeling Depressed?YesNoTrouble Sleeping?YesNoAre You Sleeping More Than NormalYesNoTrouble Concentrating?YesNoDo You Have Problems with tasks or lose track of what you are doing?Do You Feel:AnxiousNervousTenseFrightenedConfusedDo You Have Sudden Attacks?YesNoDifficulty Falling AsleepPalpitationsShortness of BreathSweatingDizzinessMuscular TensionAnxietySadnessAngerSubmit