1. I drink 2 or more cups of coffee a day.

2. My level of energy and/or fatigue fluctuates often during the day.

Yes No

3. I have headaches if I skip my morning coffee.

Yes No

4. I am in a bad mood if I don't drink at least one coffee during the day.

Yes No

5. In the afternoon, I often drink coffee, tea or cola to wake me up and/or help me concentrate.

Yes No

6. If I don't drink my coffee, I sometimes have muscle pains in my back, arms or legs.

Yes No

7. After drinking several coffees, I often feel jittery, my legs and arms shake, etc.

Yes No

8. The longer I go without drinking coffee, the worse it gets. I almost feel like I have the flu.

Yes No

9. I wake up tired.

Yes No

10. I have trouble sleeping when I drink coffee in the evening.

Yes No