Chris J.B. McDonald
bg496 at FreeNet.Carleton.CA
Thu Feb 16 00:35:12 EST 1995
February 15, 1995
My friend and I will be performing a Science fair project on the
content of caffeine in various types of coffee and tea, and will be seeing
if the general population is consuming too much/acceptable levels of
caffeine. You can help us by filling out the following questionnaire, and
returning it to me, at bg496 at freenet.carleton.ca (or just reply to this
message). If you do, we will thank you personnally in our presentation.
1) Please tell how many servings of: coffee, tea, soft drinks (and
what type), chocolate products, any medication (ie: headache pills,
wake-up pills, diet suppressants and their brand names) you consume on a
daily basis. Please include the most accurate information available, so
we may make an accurate acount of the surveyed population.
2) Please tell us if you find you have any of the following symptoms
on a regular basis: Insomnia, nervousness, irritability, agitation,
migraine headaches, rapid breathing, muscle twitching, heartburn, stomach
irritation, tremor in the hands, ringing in ears, visual flashes of light,
or impaired thinking.
3) Do you experience any of the following symptoms if you do not get
normal amount of coffee, tea, chocolate, etc? Anxiety, nervousness,
inability to wok effectively, lethargy, migraine headaches.
4) What percentage of the coffee/tea you drink is home brewed (as
opposed to work and coffee shops)?
5) Please state your City, Province/State, Country.
6) (Optional) Please state your age.
Thank you very much for having taken the time to fill out
this questionnaire. If you would like to receive a copy of our results,
please indicate that in your response.
You can help us even further by passing on a copy of this
questionnaire to any of your colleagues/family/friends, so the survey will
incorporate more people, and give us a better idea of the normal caffeine
intake of as many people as possible.
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