Odor Recognition Test Questionnaire
Please complete this questionnaire to assess your ability to recognize and identify different odors.
Participant Full Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
Have you had any issues with your sense of smell in the past 6 months?
*
No issues
Occasional loss/reduction
Frequent loss/reduction
Complete loss
Other
How would you rate your overall sense of smell?
*
1
2
3
4
5
Have you participated in an odor recognition test before?
*
Yes
No
Odor Recognition Assessment
*
Rows
Odor Detected
Odor Identified
Sample 1
1
Rose
Coffee
Lemon
Mint
Vanilla
Cinnamon
Other
Sample 2
2
Rose
Coffee
Lemon
Mint
Vanilla
Cinnamon
Other
Sample 3
3
Rose
Coffee
Lemon
Mint
Vanilla
Cinnamon
Other
Sample 4
4
Rose
Coffee
Lemon
Mint
Vanilla
Cinnamon
Other
Sample 5
5
Rose
Coffee
Lemon
Mint
Vanilla
Cinnamon
Other
How confident are you in your answers above?
*
Not confident at all
1
2
3
4
Very confident
5
1 is Not confident at all, 5 is Very confident
Do you have any allergies or medical conditions affecting your sense of smell?
None
Sinusitis
Allergic Rhinitis
Recent cold/flu
Other
Additional comments or feedback
Submit
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