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Do you drink coffee 
 
Yes
 
No
 
 
 
If Yes, How cups a day do you drink it? 
 
Only once
 
2
 
3
 
4
 
More than 5
 
I don't drink it
 
 
 
Why do you drink coffee 
 
Taste nice
 
Need to stay awake
 
Social meeting
 
Trendy
 
Addiction
 
Like the smell

 
 
 
What type of coffee do you drink?
 
Expresso
 
Skinny latte
 
Cappuccio
 
Macchiato
 
Mocha
 
Chai latte
 
Other

 
 
 
On a scale of 1 to 10, (10 being the highest).
How much do you love coffee? 
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
9
 
10
 
 
 
Do you have other sources of caffeine 
 
Energy drink
 
Tea
 
Chocolate
 
Caffeine tablets
 
Other

 
 
 
How many times per day would you consume another source of caffeine not including coffee? 
 
None
 
One
 
Two
 
Three
 
Fours
 
Five
 
Six
 
Seven
 
Eight
 
Nine
 
Ten
 
More than Ten
 
 
 
Do you think you are dependent on caffeine?? 
 
Yes
 
No
 
 
Explain your answer here..
   
 
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