Nicotine Patches
*
1.
CRL ID #:
(Required.)
*
2.
Please provide gender:
(Required.)
Male
Female
*
3.
What is your age?
(Required.)
*
4.
Are you a smoker?
(Required.)
Yes
No
*
5.
How many cigarettes do you smoke a day?
(Required.)
*
6.
Are you willing to not smoke for 24-72 hours?
(Required.)
Yes
No
*
7.
Are you willing to wear patches every other day?
(Required.)
Yes
No
*
8.
Are you willing to not smoke every other day?
(Required.)
Yes
No
*
9.
Are you willing to wear a nicotine patch?
(Required.)
Yes
No
*
10.
Do you react to adhesive patches?
(Required.)
Yes
No
*
11.
Are you an active exerciser?
(Required.)
Yes
No
*
12.
Are you willing undergo elevated temperature and humidity exposure at the end of the study?
(Required.)
Yes
No
*
13.
Please provide any other information you'd like to let us know about your activity level and smoking habits.
(Required.)
