Caffeine consumption

Caffeine's presence in my daily life

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* 1. My age group

Under 13

13-18

18-24

25-40

41-54

55-64

65+

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* 2. I wake up to a caffeinated beverage in the morning (First meal before/after water). Caffeine is found in Black/White/Green Tea, Coffee, Decaf Coffee, chocolate, Cola

Agree

Disagree

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* 3. I take at least one cup of below beverage/ beverages daily (may select multiple)

Black Tea with or without milk/cream

Black Coffee with or without milk/cream

Decaf Coffee with or without milk/cream

Green Tea

White Tea

Hot Chocolate

Cola

Herbal Concoction (Non Caffeinated)

None of these

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* 4. If I don't get caffeine daily, I experience headache /fatigue/ lethargy/ low energy/ poor concentration/ less motivation

Agree

Disagree

Not Applicable

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* 5. I drink ‘x’ cups of caffeinated beverages daily

None

2-3

4-6

More than 6

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* 6. My last cup of caffeine is at

By 12 p.m.

12-3 p.m.

3-6 p.m.

6-9 p.m.

After 9 p.m.

Not Applicable

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* 7. I often opt for caffeinated beverage when I am...(may select multiple)

Catching up with my friends/ informal gatherings (Morning- Day)

Meeting up clients, Interview , Formal gatherings at work

Catching up with my friends/ informal gatherings (Evening-Night)

Working on tough deadlines/ Under stress/ less energetic/ enthusiastic

None of these

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* 8. On an average I sleep for 7-8 hours every night

Mostly

Sometimes

Rarely

Never

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* 9. I wake up during night

Once or twice to urinate then I immediately fall off to sleep

Several times to urinate then I immediately fall off to sleep

Once or several times but I struggle to fall asleep again

Never

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* 10. I wake up energetic and fresh in the morning

Strongly agree

Agree

Disagree

Strongly disagree