1. How much do you weigh?

2. Do you drink at least one caffeinated beverage daily?

YES NO

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

YES NO

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

YES NO

5. Are you trying to lose weight?

YES NO

6. Are you sick or taking medications?

YES NO

7. Are you pregnant?

YES NO

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

YES NO

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

YES NO

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

YES NO

11. Do you take nutritional supplements?

YES NO

12. Do you have a high sugar diet?

YES NO