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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* 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.

Name

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* 2. Name

Gender

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* 3. Gender

Where do you live?

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* 4. Where do you live?

How would you prefer to be contacted?

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* 5. How would you prefer to be contacted?

Do you have any medical conditions?

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* 6. Do you have any medical conditions?

Are you taking any medications?

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* 7. Are you taking any medications?

Do you smoke?

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* 8. Do you smoke?

Do you drink alcohol?

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* 9. Do you drink alcohol?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Are you allergic to any medications?

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* 17. Are you allergic to any medications?

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