undefined
HomeAll templatesdisorder surveyscaffeine use disorder survey

Caffeine Use Disorder Survey

The Caffeine Use Disorder Survey is a questionnaire that assesses an individual's caffeine use and possible dependence. The survey consists of questions about an individual's caffeine consumption habits, including how much caffeine they consume and how often they consume it. The survey also includes questions about an individual's physical and mental health, as well as their social and work life.

Time to complete

2 minutes

Eligibility

To be eligible to fill out the Caffeine Use Disorder Survey, an individual must be 18 years of age or older.

undefined

Questions for Caffeine Use Disorder Survey

1.

How much caffeine do you consume on a daily basis?

The answer should be a text input.
2.

How often do you consume caffeine?

The answer should be a text input.
3.

What are the reasons you consume caffeine?

The answer should be a text input.
4.

Do you experience any negative side effects from caffeine consumption?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
5.

Do you feel like you need to consume caffeine in order to function properly?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
6.

Has your caffeine consumption ever interfered with your work or social life?

The answer should be a text input.
7.

Do you think you may be dependent on caffeine?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
8.

Would you like to cut back on your caffeine consumption?

The answer should be a text input.
9.

What are your thoughts on caffeine?

The answer should be a text input.

Similar Ideas

  • Caffeine Use Disorder Identification Test
  • Caffeine Intoxication Symptom Scale
  • Caffeine Withdrawal Symptom Scale

Here are some FAQs and additional information
on Caffeine Use Disorder Survey

What is the Caffeine Use Disorder Survey?

The Caffeine Use Disorder Survey is a tool used to assess whether someone is at risk for developing a caffeine use disorder.

Who can take the Caffeine Use Disorder Survey?

The Caffeine Use Disorder Survey is intended for use by adults 18 years of age and older.

How long does it take to complete the Caffeine Use Disorder Survey?

The Caffeine Use Disorder Survey takes about 5 minutes to complete.

What does the Caffeine Use Disorder Survey measure?

The Caffeine Use Disorder Survey measures symptoms of caffeine use disorder, including dependence and tolerance.

How is the Caffeine Use Disorder Survey scored?

There is no scoring for the Caffeine Use Disorder Survey. The survey is intended to be used as a tool to assess whether someone is at risk for developing a caffeine use disorder.

Want to use this template?

Loved by people at home
and at work

undefined
“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
undefined
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
BlockSurvey social proof
G2 Crowd
4.8 Star Rating
BlockSurvey social proof
Dapp.com
Editor's choice
BlockSurvey social proof
Capterra
4.9 Star Rating

What's next? Try out templates like
Caffeine Use Disorder Survey

1000+ Templates, 50+ Categories

Explore more
undefined
Panic Disorder Test
Panic disorder test is a psychological assessment tool used to identify symptoms of panic disorder, a type of anxiety disorder. 
undefined
Perceptions On Eating Disorder Survey
The Perceptions On Eating Disorder Survey is a survey designed to measure how people perceive eating disorders. The survey consists of questions about how people think about eating disorders, how much they know about eating disorders, and how they think people with eating disorders should be treated.
undefined
Autism Spectrum Disorder Survey
The Autism Spectrum Disorder Survey is a questionnaire used to screen individuals for autism spectrum disorder (ASD). The survey consists of questions about social and communication skills, repetitive behaviors, and interests. The survey is intended to be used by clinicians and researchers to identify individuals who may be on the autism spectrum.
undefined
Neurological Disorder Detection Survey
The Neurological Disorder Detection Survey is a questionnaire that is used to help identify individuals who may be suffering from a neurological disorder. The survey consists of questions about symptoms and medical history, and is used to help doctors diagnose and treat neurological disorders.
undefined
Caffeine Use Disorder Survey
The Caffeine Use Disorder Survey is a questionnaire that assesses an individual's caffeine use and possible dependence. The survey consists of questions about an individual's caffeine consumption habits, including how much caffeine they consume and how often they consume it. The survey also includes questions about an individual's physical and mental health, as well as their social and work life.
undefined
Paid Anxiety Disorder Survey
The Paid Anxiety Disorder Survey is a tool used to assess the severity of anxiety disorders. It is a self-report measure that asks questions about the frequency and intensity of symptoms, as well as the impact of anxiety on daily functioning. The Paid Anxiety Disorder Survey can be used to diagnose anxiety disorders, track the severity of symptoms over time, and monitor the efficacy of treatment.
undefined
Autism Disorder Parent Survey
The Autism Disorder Parent Survey is a questionnaire that is used to gather information from parents about their child's autism diagnosis. The survey covers topics such as the child's symptoms, diagnosis, and treatment.
undefined
Gender And Personality Disorder Survey
The Gender And Personality Disorder Survey is a tool used to screen for personality disorders in adults. It is a quick and easy way to determine if someone may be suffering from a personality disorder, and can help direct them to appropriate treatment.
undefined
Sleep Disorder Survey
The Sleep Disorder Survey is a tool used to evaluate sleep disorders. It is a self-report measure that includes questions about sleep habits and experiences. The survey can be used to help diagnose sleep disorders and to track the severity of symptoms over time.
undefined
Dissociative Identity Disorder Survey
The Dissociative Identity Disorder Survey is a questionnaire that is used to screen for dissociative identity disorder (DID). The survey consists of 26 items that ask about symptoms of DID, such as dissociative amnesia and identity confusion. The survey also includes questions about other mental health disorders, such as depression and anxiety.
undefined
Post Traumatic Stress Disorder Survey
The Post Traumatic Stress Disorder Survey is a self-report measure of post-traumatic stress disorder symptoms. The survey includes questions about exposure to traumatic events, symptoms of post-traumatic stress disorder, and functional impairment.
undefined
Shared Psychotic Disorder Survey
The Shared Psychotic Disorder Survey is a questionnaire that is used to assess the presence of shared psychotic disorder in a group of people. The survey consists of a series of questions about the group's beliefs and behaviors, as well as about the individual's own experiences.
undefined
Public Opinion On Bipolar Disorder Survey
The Public Opinion On Bipolar Disorder Survey asked respondents their opinions on bipolar disorder and its treatments. The results showed that the majority of respondents believed that bipolar disorder is a real and serious mental illness, and that its treatments are effective. However, a significant minority of respondents also believed that bipolar disorder is a made-up condition, and that its treatments are ineffective.
undefined
Anger Disorder Survey
The Anger Disorder Survey is a tool used to help diagnose and treat patients with anger disorders. The survey consists of questions about the frequency and severity of angry outbursts, as well as questions about the impact of anger on daily life.
undefined
Gastrointestinal Disorder Survey
The Gastrointestinal Disorder Survey is a tool used to assess the severity of gastrointestinal symptoms and to identify possible causes of these symptoms. The survey includes questions about the frequency and intensity of symptoms, as well as about possible triggers for these symptoms.
undefined
Antisocial Personality Disorder Survey
The Antisocial Personality Disorder Survey is a short, self-report questionnaire that asks questions about your thoughts, feelings, and behaviors. It is used to help diagnose antisocial personality disorder, a mental health condition characterized by a pattern of disregard for and Violation of the rights of others.
undefined
Cerebral Palsy Dysphagia Disorder Survey
The Cerebral Palsy Dysphagia Disorder Survey is a questionnaire that asks about your experiences with dysphagia, or difficulties swallowing. The survey is designed to help researchers better understand the impact of dysphagia on people with cerebral palsy, and to develop new treatments for the condition.
undefined
Mood Disorder Survey
The Mood Disorder Survey is a tool used to help mental health professionals diagnose and treat mood disorders. The survey is completed by the patient and covers a wide range of topics related to mood, including symptoms, family history, and current stressors.
undefined
Sensory Processing Disorder Survey
The Sensory Processing Disorder Survey is a tool used to help identify individuals who may have Sensory Processing Disorder. This disorder is characterized by difficulties in processing and responding to sensory information. The survey consists of questions about an individual's symptoms and how they affect daily life.
undefined
Panic Disorder Survey
The Panic Disorder Survey is a tool used by mental health professionals to help diagnose panic disorder. It is a structured interview that assesses the severity of symptoms and impairment associated with panic disorder.
undefined
Substance Use Disorder Survey
The Substance Use Disorder Survey is a tool used to assess an individual's level of substance use and potential for substance abuse. It is made up of a series of questions about an individual's use of drugs and alcohol, as well as their attitudes and beliefs about substance use.
undefined
Sexism Mental Disorder Survey
The Sexism Mental Disorder Survey is a questionnaire that is used to assess an individual's level of sexism. The survey consists of a series of questions that ask about an individual's attitudes and beliefs regarding gender roles, gender stereotypes, and sexism. The survey is intended to help identify individuals who may be at risk for developing sexist attitudes and beliefs.
undefined
Multiple Personality Disorder Survey
The Multiple Personality Disorder Survey is a questionnaire that is used to screen for symptoms of multiple personality disorder (MPD). The survey includes questions about dissociative symptoms, such as identity change, amnesia, and depersonalization. It also assesses for symptoms of other mental disorders, such as depression, anxiety, and post-traumatic stress disorder.

Want to create secure online forms and surveys?

Join BlockSurvey.

SHARE