HOW YOU FEELING TODAY?

Questions marked with an * are required

IF YOU ARE ON PRESCRIBED MEDICATION BY A DOCTOR:
Do you rely on the medication too...

Ensure all your work is completed

Ensure you concentrate the entire day

Reduce anxiety

Know you are enhancing your concentration and therefore feel smarter

Other

Could you cope without concentration medication?

YES

NO

* Do you study for long hours?

Yes

No

Until I get board with the work

Until I get distracted

* Do you take any substance to sustain your concentration?

Yes

No

In order to concentrate to do you take:

Medication prescribed by a doctor

Herbal substance

Coffee (any form of caffeine)

Vitamins

Other

Do you feel more or less concentrated after taking a substance?

More

Less

I don't rely on a substance to concentrate

Do you feel more or less anxious after you have taken a substance to help you?

More

Less

I never feel anxious

I am always anxious