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* 1. I consent to be contacted by Dr Chamberlain's Research Team at the University of Cambridge about studies that may be of interest to me.
I understand that my information will be treated confidentially and will not be shared with anyone outside the research team.

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* 2. Name

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* 3. Gender

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* 4. Where do you live?

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* 5. How would you prefer to be contacted?

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* 6. In what year were you born? (enter 4-digit birth year; for example, 1986)

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* 7. Do you have any medical conditions?

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* 8. Are you taking any medications?

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* 9. Do you smoke?

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* 10. Do you drink alcohol?

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* 11. Have you used any illicit substance(s), in the past six months? (e.g. cannabis, cocaine, ecstasy...)

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* 12. Have you felt depressed and down, most of the day, nearly every day, for the past week?

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* 13. Have you ever been diagnosed with bipolar disorder, psychosis, or personality disorder?

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* 14. Have you ever been diagnosed with anxiety disorder, panic disorder, obsessive compulsive disorder (OCD), or attention deficit hyperactivity disorder (ADHD)?

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* 15. Have you ever been diagnosed with a mental health condition by a professional (such as your doctor)?

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* 16. Are you allergic to any medications?

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* 17. If you are female we will ask you to use highly effective contraception during the study. Examples of highly effective contraception include implants, injectables, combined oral contraceptives, some intrauterine devices or having a vasectomised partner. Would you agree to this?

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* 18. Have you ever had a major head injury that led to an inpatient hospital stay?

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* 19. Have you taken part in any similar research studies in the last three months?

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* 20. Do you have any metallic implants in your body (e.g. a pacemaker)? 

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* 21. Do you have any metallic jewellery on your body that cannot be removed?

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