* 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.

* 2. Name

* 3. Gender

* 4. Where do you live?

* 5. How would you prefer to be contacted?

* 6. Do you have any medical conditions?

* 7. Are you taking any medications?

* 8. Do you smoke?

* 9. Do you drink alcohol?

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

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

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

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

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

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

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

* 17. Are you allergic to any medications?

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