C. Questionnaires
I. Adult Questionnaire
ATS-DLD-78-A
A. ADULT QUESTIONNAIRE — SELF-COMPLETION
(for those 13 years of age and older)
Thank you for your willingness to participate. You were selected by a scientific sampling procedure, and your cooperation is very important to the success of the study.
This is a questionnaire you are asked to fill out. Please answer the questions as frankly and accurately as possible. ALL INFORMATION OBTAINED IN THE STUDY WILL BE KEPT CONFIDENTIAL AND USED FOR MEDICAL RESEARCH ONLY. Your personal physician will be informed about the test results if you desire.
The questions can be answered by checking the best answer or by filling in a blank with a number or word.
Example: Do you live in the United States 1. Yes ✓v
2, No
If you desire help in answering a question, please put a check (✓) in front of the question number. You will be helped with these questions at the time of your appointment.