Pre-screening questionnaire

Thank you for your interest in our study.  This study explores the effect of beans on cholesterol levels.  This study involves three 4-week treatment periods that require consuming beans at home every day. There is 1 screening visit and 9 study visits to our downtown Toronto clinic, where blood samples, fecal samples, and questionnaires will be collected.  Participants will receive $1200 if they successfully complete the study.

Please answer the following questions so that we can determine if you are eligible to participate in the study.  Completion of this survey is entirely voluntary and you can choose to discontinue the survey at any time.

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your email address?

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* 4. What is your phone number?

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* 5. Are you male or female? 

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* 6. Are you currently pregnant, planning to become pregnant, or breastfeeding?

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* 7. What is your age?

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* 8. What is your height? (cm)

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* 9. What is your weight? (kg)

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* 10. Have you gained or lost more than 9 lbs over the past 3 months?

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* 11. Do you drink more than 2 alcoholic drinks per day?

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* 12. Do you agree to refrain from cannabis use during this study?

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* 13. Do you regularly smoke more than 5 cigarettes per week?

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* 14. Do you currently use cholesterol-lowering medication or medication to treat diabetes?

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* 15. Have you been diagnosed with any medical conditions or disorders?

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* 16. If yes, please list them here

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* 17. Do you have any allergies/food sensitivities?

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* 18. If yes, please list them here

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* 19. Do you regularly consume more than 4 servings of pulses per week?

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* 20. Have you used antibiotics in the past 3 months?

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* 21. Are you currently using a probiotic or dietary fibre supplement?

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* 22. Are you a national-level or professional athlete?

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* 23. Are you an overnight shift worker?

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* 24. Have you had a major trauma or been hospitalized for a medical condition in the past 3 months?

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* 25. Do you provide us with your consent to maintain your personal information provided in this survey within our database and to be contacted for future studies?

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