Study: COPD Date:Tuesday, August 26th, 2008 Incentive: $80.00 Length: 45 minutes Time: Various times available throughout the day Name: _____________ Age: ______________ Home Phone: _____________ Wk Phone: ______________ Cell Phone: _____________ Please reply with your answers to the following questions: 1.Do you currently or have you ever smoke cigarettes? 2.Have you been diagnosed with the following: Arthritis asthma chronic Bronchitis chronic Obstructive Pulmonary Disease (COPD) Depression Emphysema High blood pressure (Hypertension) High cholesterol Nasal allergies / Hay fever None of the above If so, what medications are you taking for any of the mentioned conditions? (Please forward the email onto people with any of these conditions to reply) Thank you