Cough data form

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We respect your privacy and contribution. We do not collect any sensitive personal data (e.g., Name, Phone no, Email, Location) We are doing research on detecting COVID-19 using cough sound, fever and other vital information. We need your contribution in this research, please help us by filling the form with correct symptoms & respective details.

Before filling the form or submitting your cough/ sound samples, please make sure that you are away or at a considerable distance from other people (as you shall be coughing). Also please make sure that there is no disturbance or noise in the background. Once you have submitted the form, please disinfect your electronic device as well as any surfaces that you may have coughed on.

Your contribution can save lives.

If you wish to participate in the research, select the checkbox below.
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I wish to Participate in the research to fight against Covid-19* This field is required.
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1) Patient Unique ID* This field is required.
ex : Healthy129, NA etc..
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2) I am* This field is required.
Tested and Covid-19 postive
Tested and Covid-19 Negative
Waiting for the result
Haven't tested yet
Healthy
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3) When did you get tested positive?
Leave it, if you are healthy
Month
Day
Year
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4) What is your biological sex?* This field is required.
Male
Female
Other
Prefer not to say
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5) What is your age? * This field is required.
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6) Do you have any of these medical conditions? (select all that apply)* This field is required.
None
Asthma
High Blood pressure
Previous heart attack
Heart disease
Diabetes
Cancer
Tuberculosis
Lung Disease
Other
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7) Do you have any of the following symptoms TODAY (In Present) ? (select all that apply)* This field is required.
None
Fever
Chills
Dry cough
Wet cough
Difficult breathing or short of breath
Tightness in your chest
loss of taste and smell
Dizziness, confusion or vertigo
Headache
Muscle aches
Sore throat
Diarrhoea
Pneumonia
Cold
Other
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8) If you are having cough, when it started?* This field is required.
I don't remember
Less than a week ago
More than a week ago
Less than three days ago
I don't cough
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9) If you reported having a cough, what type of cough do you have?* This field is required.
I don't have cough
I don't know the type
I don't have cough but I tested COVID-19 positive
I am having continuous dry cough
I am having wet cough
I had an asthma cough
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10) Do you smoke or had smoking habit in past?* This field is required.
I don't smoke
Ex-smoker
Current smoker (Heavy)
Current smoker (frequent)
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Cough Recordings

During recording your cough, If possible, move to a quiet place, without any distractions or background noise.

Please open this form in Chrome browser, Allow chrome permission to use your microphone. if you are still facing issues while recording please try using a laptop instead of the phone.

To record your cough Press 'Record', press 'Stop' to stop, and 'Play' to review your recording. before submitting the form make sure cough was recorded correctly. You can re-record it as many times as you like.

We need your three cough recordings, each recording should be at least a few seconds long (around 2-3 seconds)., Please click on the “record” buttons and cough three times for each recording.
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Sample Cough sound recording 1
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11) Cough sound recording 1 * This field is required.
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Sample Cough sound recording 2
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12) Cough sound recording 2 * This field is required.
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Sample Cough sound recording 3
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13) Cough sound recording 3 * This field is required.
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Press 'record' below and breathe in and out from your mouth as deeply as you can five times.
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Sample Breathe Recording
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14) Breathe Recording * This field is required.
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Speech Samples

We need to collect a few samples of your natural voice.
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Sample Count 1 to 10 slowly in English
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15) Count 1 to 10 slowly in English* This field is required.
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Sample Say the vowel "ee" for as long as you can: EEEE (atleast 5-6 sec)
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16) Say the vowel "ee" for as long as you can: EEEE (atleast 5-6 sec)* This field is required.
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Sample Say the vowel "o" for as long as you can: OOOO
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17) Say the vowel "o" for as long as you can: OOOO (atleast 5-6 sec)* This field is required.
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Sample Say the vowel "a" for as long as you can: AAAA
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18) Say the vowel "a" for as long as you can: AAAA (atleast 5-6 sec)* This field is required.
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19) Did you use mask to record the cough and other sounds?* This field is required.
I didn't wear any mask during recording
I wore a surgical / cloth mask during recording
I wore a N-95 mask during recording
I wore a different type of mask during recording
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If you face any recording issues (mic problem, browser issue) You can record three cough recordings from your phone and upload the files here.

No need to upload, If you already have recorded cough using this form.
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Cough recording 1
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Cough recording 2
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Cough recording 3
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Breathe recording
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
Should be Empty: