Screening

Screening Questionnaire

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Gender:

Male

Female

Age:

Height (in cm):

Weight (in kg):

Do you smoke?

Yes

Please indicate how many cups of coffee you drink on an average day:

1-3

4-6

7-10

>10

Please indicate how many units of alcohol you drink on an average week.
One unit = 1 glass wine or 1 beer:

1-5

6-10

11-15

16-20

>20

Do you currently use medication?

Yes

Please specify the medication you use:

Do you have a milk allergy?

Yes

Anxiety Questionnaire:

Printed below are a number of statements which people have used to describe themselves. Read each statement and then tick the appropriate circle to the right of the statement to indicate how you generally feel. There are no right or wrong answers. Do not spend too much time on any one statement but give the answer which seems to describe your general feelings best and NOT how you feel right now.

	Almost never	Sometimes	Often	Almost always
1. I feel pleasant	Almost never	Sometimes	Often	Almost always

2. I feel nervous and restless	Almost never	Sometimes	Often	Almost always

3. I feel satisfied with myself	Almost never	Sometimes	Often	Almost always

4. I wish I could be as happy as others seem to be	Almost never	Sometimes	Often	Almost always

5. I feel like a failure	Almost never	Sometimes	Often	Almost always

6. I feel rested	Almost never	Sometimes	Often	Almost always

7. I am "Calm, cool and collected"	Almost never	Sometimes	Often	Almost always

8. I feel that difficulties are piling up so that I cannot overcome them	Almost never	Sometimes	Often	Almost always

9. I worry too much over something that really doesn't matter	Almost never	Sometimes	Often	Almost always

10. I am happy	Almost never	Sometimes	Often	Almost always

	Almost never	Sometimes	Often	Almost always
11. I have disturbing thoughts	Almost never	Sometimes	Often	Almost always

12. I lack self confidence	Almost never	Sometimes	Often	Almost always

13. I feel secure	Almost never	Sometimes	Often	Almost always

14. I make decisions easily	Almost never	Sometimes	Often	Almost always

15. I feel inadequate	Almost never	Sometimes	Often	Almost always

16. I am content	Almost never	Sometimes	Often	Almost always

17. Some unimportant thought runs through my mind and bothers me	Almost never	Sometimes	Often	Almost always

18. I take disappointments so keenly that I can't put them out of my mind	Almost never	Sometimes	Often	Almost always

19. I am a steady person	Almost never	Sometimes	Often	Almost always

20. I get in a state of tension or turmoil as I think over my recent concerns and interests	Almost never	Sometimes	Often	Almost always

Lastly, in case you meet our eligibility criteria and if you are interested to participate in our study we would like to contact you again. Could you therefore please provide us with your e-mail address?

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Screening

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