Alethios - Botanical Supplement for Acute Stress & Anxiety Relief Screening

Welcome to the Anxiety Study Screening

Please answer the following questions to verify your eligibility. Your answers will be reviewed by the research team before you are approved to join the study. You will also be asked to provide your mailing address so your supplement can be mailed to you with a unique identification code that will allow you to begin the study. This questionnaire will ask you about your situational anxiety and stress; it should take 2-3 minutes to complete.

How Your Responses Will Be Handled*

Your responses will be kept confidential. All participants will receive an email confirming their eligibility status (eligible or ineligible). Your responses for this study will be stored to determine eligibility for this study only, and will not be used for any other study. If you are ineligible, your response will not be shared with the research team, but will be stored on the Alethios platform until the study is closed to prevent fraud, "gaming" and using multiple responses from the same individual. All responses from ineligible participants will be deleted at the conclusion of the study, If ineligible, you may later choose to share *only* your name and email address with the Alethios platform to be contacted for other studies you may be eligible for in the future. No other response data will be stored. Please consent to the use of your response as explained above. If you do not consent to the use of your response in this way, you may exit this pre-screener, and no data will be stored.

Yes, I consent.

No, I do not consent.

What is your name?*

Please enter your full legal name.

What is your email?*

What is your gender?*

Male

Female

Other

What is your height in feet and inches?*

Characters Remaining: 12

What is your weight in pounds?*

Medical & Medication History

Are you taking any of the following medications regularly?*

Select all that apply.

Statins

Metformin

Immunosuppressants

Antidepressants

Anti-anxiety medication

Blood pressure medication

None of the above

Other

If you are a female of childbearing potential, do you agree to use an effective method of birth control during the study?*

Yes

No

Not applicable

Are you currently pregnant or planning to become pregnant during the study period?*

Yes

No

Not applicable

Do you have any known allergies or sensitivities to the following ingredients?*

Sceletium

Microcrystalline cellulose (a common filler in medications and food products)

None of the above

Lifestyle and Compliance

On average, how often do you experience episodes of acute stress or situational anxiety?*

Daily - 1 or more times per day

Weekly - 1-6 times per week

Monthly - 1-3 times per month

Seldom - less than 1 time per month

Do you agree to maintain your existing dietary patterns throughout the study period?*

Any major lifestyle changes can be reported via the platform if they occur.

Yes

No

Do you agree to abstain from using any dietary supplements that are thought to or known to affect your mood (outside of the study treatment) for the duration of the study?*

e.g. ashwagandha, L-theanine, saffron, St. John's Wort etc.

Yes

No

How often have you used cannabis in the past 6 weeks?*

Never

Once or twice a week

3-4 times a week

5-8 times a week

More than 8 times a week

Do you agree not to use cannabis during the active study period?*

Yes

No

On average, how many alcoholic drinks do you consume per week?*

An alcoholic drink could be a glass of wine, a beer, a mixed drink etc.

Have you experienced any history of drug abuse or dependence within the past 6 months?*

e.g., therapy, medication, hospitalization

Yes

No

Have you received a new prescription medication for any health condition within the past 3 months?*

These could be for both physical or psychological health conditions.

Yes

No

Have you received a new diagnosis for a mental health condition within the past 3 months?*

Yes

No

Do you have any unstable medical conditions that could interfere with your participation?*

e.g., severe cardiovascular disease, active cancer treatment, etc.

Yes

No

Have you participated in a clinical study within the past 30 days?*

If you are participating in other studies via the Alethios platform, you will be automatically removed from the study during the onboarding phase.

Yes

No

Instructions

Over the last 2 weeks, How often have you been bothered with any of the following problems in the following questions?

Little interest or pleasure in doing things*