Quick Questionnaire

    (1) How much do you weigh?

    (2) Do you drink at least one caffeinated beverage daily?

    YesNo

    (3) Do you drink 10 or more alcoholic beverages per week?

    YesNo

    (4) Do you exercise or work to the point of perspiring regularly?

    YesNo

    (5) Are you trying to lose weight?

    YesNo

    (6) Are you sick or taking medications?

    YesNo

    (7) Are you pregnant?

    YesNo

    (8) Will you be traveling by plane in the next 3-5 days?

    YesNo

    (9) Do you smoke, are you regularly exposed to 2nd hand smoke
    or do you live/work in a city with air quality problems?

    YesNo

    (10) Do you have arthritis, minor back pains or indigestion?

    YesNo

    (11) Do you take nutritional supplements?

    YesNo

    (12) Do you have a high sugar diet?

    YesNo