Covit 19 Interview Form

The Covit 19 questionnaire is available to everyone.

This site is open to the public on a trial basis for research purposes. Please read the "Terms of Use" at the top right.
It is available in English, Chinese, Thai, Nepali, Portuguese, Spanish, Filipino and Indonesian.

All of them are written in Japanese, so the English version of the site can be used by Japanese users as well.
From the point of view of personal information, there is no column for entering personal information.

If you want to use this site, you can fill it out and print it out.
If you would like to actually use this service, please contact us using the contact form below, as we can customize it for each medical institution. However, please note that not all requests can be met.

We also welcome contacts from companies and research institutes that wish to collaborate with us.

Click here for the covit19 questionnaire.  👉