ALMCVH POMS

Email Address*

Please use the email address that we use to send your study reminders (this is so our system can identify that you have completed this questionnaire).

First Name

Last Name

Mobile Number*

Participant ID*

Your participant ID is noted on the top of your participant information provided with your trial product. However, if in doubt, please just use your initials, followed by the day and month of your birth. For example GA0210

Product Number

Please enter a number from 1 to 150.

Please select which time point you are completing this questionnaire for.*

Profile of Mood States

Describe how you feel RIGHT NOW by checking the most appropriate box after each of the words listed below.

Tense*

Angry*

Worn out*

Unhappy*

Proud*

Lively*

Confused*

Sad*

Active*

On edge*

Grouchy*

Ashamed*

Energetic*

Hopeless*

Uneasy*

Restless*

Unable to concentrate*

Fatigued*

Competent*

Annoyed*

Discouraged*

Resentful*

Nervous*

Miserable*

Confident*

Bitter*

Exhausted*

Anxious*

Helpless*

Weary*

Satisfied*

Bewildered*

Furious*

Full of pep*

Worthless*

Forgetful*

Vigorous*

Uncertain about things*

Bushed*

Embarrassed*

Profile of Mood States

Weight Loss

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