Postage:• Place the Uriswab Bag (1 & 2) and the completed questionnaire into the reply paid envelope.• Seal the envelope.• Deposit the reply paid envelope in an Australia Post box.

QU

ESTION

NA

IRE

WEEK 3

STUD

Y ID:

AB

OU

T OM

EGA M

OU

THW

ASH

1. In the last 21 days (i.e. 3 w

eeks), how m

any days did you use the OM

EGA m

outhwash? (P

lease

estimate the num

ber of days from 0 to 21). ____________________ days

2. In the last 21 days, on average, how

many tim

es did you use the OM

EGA m

outhwash per day?

N

ever in the last 21 days

1 tim

e per day

2 times per day

In the last 21 days did you rinse or gargle with the O

MEG

A mouthw

ash?

dd mm

yy

Date: ________/________/

Your Study ID

OMEGABag 1

BIOHAZARD

SPECIMEN ONLY

OMEGABag 2

Reply Paid 80000

OMEGA

Attn: Eric Chow

Melbourne Sexual Health

580 Swanston Street

Carlton 3050

No stamp required

If posted in Australia

Questionnaire:• Wash your hands with soap and water.• Complete the questionnaire provided.

QUESTIONNAIRE

WEEK 12

STUDY ID:

dd

mm

ABOUT OMEGA MOUTHWASH

1. In the last 21 days (i.e. 3 weeks), h

ow many days did you use the OMEGA mouthwash?

(Please estimate the number of days from0 to 21). _

___________________ days

2. In the last 21 days, on average, how many times did you use the OMEGA mouthwash per day?

Never in the last 21 days

2 times per day

1 time per day

3 or more tim

es per day

3. In the last 21 days did you rinse or gargle with the OMEGA mouthwash?

Rinse only

Gargle only

4. In the last 21 days, on average, how long did you use the OMEGA mouthwash per rinse/gargle?

Less than 10 seconds per rinse/gargle

10-30 seconds time per rin

se/gargle

30-60 seconds per rinse/gargle

More than 60 seconds per rinse/gargle

5. When did you usually use the OMEGA mouthwash during the study period (last 12 weeks)?

(Please ‘P’ the most appropriate category)

AMorning

BAfternoon

CNight

DBefore/after m

eal

EF

Date: _

_______/________/

Seal and bag sample:• Place the Uriswab swab, making sure to screw the lid on tight into bag 1 and seal.• Place Bag 1 into bag Bag 2 and seal bag 2.

OMEGABag 1

OMEGABag 1

BIOHAZARD

SPECIMEN ONLY

OMEGABag 2

Completing the sample collection:• Put the lid back on the saliva jar and discard.• Place the Uriswab back into the tube and seal firmly.• Write the date you collected the saliva sample on the Uriswab.

RubbishBin

Saliva Jar

Collecting the saliva sample:• Open the small yellow top tube (Uriswab) you will see a sponge attached to the lid. • Swirl the absorbent sponge in the saliva for 30 sec. You may have to tilt and rotate the sponge several times into the saliva to ensure maximum coverage of the sponge area.

Saliva Jar

S aliva Jar

Preparing for the saliva sample:• Accumulate saliva in your mouth for about 30 sec to get a reasonable saliva sample.• Spit as much saliva into the saliva jar as possible.

To start:• Wash your hands thoroughly with soap and water.• Remove the lid from the saliva jar in preparation to spit into the jar.

S aliva Jar

1

QUESTIONNAIRE WEEK 3

STUDY ID:

ABOUT OMEGA MOUTHWASH 1. In the last 21 days (i.e. 3 weeks), how many days did you use the OMEGA mouthwash? (Please

estimate the number of days from 0 to 21). ____________________ days

2. In the last 21 days, on average, how many times did you use the OMEGA mouthwash per day?

Never in the last 21 days 1 time per day 2 times per day 3 or more times per day

3. In the last 21 days did you rinse or gargle with the OMEGA mouthwash?

Rinse only Gargle only Both rinse and gargle

4. In the last 21 days, on average, how long did you use the OMEGA mouthwash per rinse/gargle?

Less than 10 seconds per rinse/gargle 10-30 seconds time per rinse/gargle 30-60 seconds per rinse/gargle More than 60 seconds per rinse/gargle

ABOUT HEALTH INFORMATION5. In the last 21 days, have you taken antibiotics for any reason?

Yes. Name of antibiotic(s): ________________ Reason(s): ___________________ No Unsure

dd mm yyDate: ________/________/

b

What’s in the kit:a) A padded bag for reply paid postageb) A questionnaire c) 2 plastic zip-lock bags (OMEGA Bag 1 & OMEGA Bag 2)d) A small yellow topped tube (Uriswab) e) A large yellow topped jar (saliva jar) f) This instruction sheet about saliva collection

Postage:

• Place the Uriswab Bag (1 & 2) and the completed

questionnaire into the reply paid envelope.

• Seal the envelope.

• Deposit the reply paid envelope in an Australia

Post box. Questionnaire

Testme.org.au

Thank you for taking the

time to fill in this survey

which will help us to evaluate this new service.

Your comments will help

us improve the service.This survey should only

take 10 mins of your time.

OMEGABag 1

BIOHAZARD

SPECIMEN ONLY

OMEGABag 2

Reply Paid 80000OMEGAAttn: Eric ChowMelbourne Sexual Health580 Swanston StreetCarlton 3050 No stamp required

If posted in Australia

Questionnaire:

• Wash you hands with soap and water.

• Complete the questionnaire provided.

QUESTIONNAIREWEEK 12

STUDY ID:

dd mm

ABOUT OMEGA MOUTHWASH 1. In the last 21 days (i.e. 3 weeks), how many days did you use the OMEGA mouthwash?

(Please estimate the number of days from0 to 21). ____________________ days2. In the last 21 days, on average, how many times did you use the OMEGA mouthwash per day?

Never in the last 21 days 2 times per day

1 time per day 3 or more times per day

3. In the last 21 days did you rinse or gargle with the OMEGA mouthwash? Rinse only

Gargle only

4. In the last 21 days, on average, how long did you use the OMEGA mouthwash per rinse/gargle? Less than 10 seconds per rinse/gargle

10-30 seconds time per rinse/gargle 30-60 seconds per rinse/gargle

More than 60 seconds per rinse/gargle5. When did you usually use the OMEGA mouthwash during the study period (last 12 weeks)?

(Please ‘P’ the most appropriate category)

AMorning

BAfternoon

CNight

DBefore/after meal

EF

Date: ________/________/

Seal and bag sample:

• Place the Uriswab tube into Bag 1, making

sure to screw the lid on tight.

• Place Bag 1 into bag Bag 2 and seal bag.

OMEGABag 1

OMEGABag 1BIOHAZARD

SPECIMEN ONLY

OMEGABag 2

Completing the sample collection:

• Put the lid back on the saliva jar and

discard.

• Write the date of when you collected the

sample on the Uriswab.

Rubbish

Bin Sali va

Jar

Collecting the saliva sample:

• Open the small yellow top tube (Uniswab) you will

see a sponge attached to the lid.

• Swirl the absorbent sponge in the saliva for 30 sec.

You may have to tilt and rotate the sponge several

times into the saliva to ensure maximum coverage

of the sponge area. Saliva

Jar

Saliva Jar

Preparing for the saliva sample:

• Accumulate saliva into your mouth for about

30 sec to get a reasonable saliva sample.

• Spit as much saliva into the saliva jar

as possible.

To start:

• Wash your hands throughly with soap and water.

• Remove the lid from the saliva jar in preparation

to spit into the jar.

Sal iva

Jar

QuestionnaireTestme.org.au

Thank you for taking the

time to fill in this survey

which will help us to

evaluate this new service.

Your comments will help

us improve the service.

This survey should only

take 10 mins of your time.

b

What’s in the kit:

a) A padded bag for reply paid postage

b) A questionnaire

c) 2 plastic zip-lock bags (OMEGA Bag 1 & OMEGA Bag 2)

d) A small yellow topped tube (Uniswab)

e) A large yellow topped jar (saliva jar)

f) This instruction sheet about saliva collection

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deriuqer pmats oN ailartsuA ni detsop fI

Questionnaire

Testme.org.au

Thank you for taki ng the time t o fil l in this survey whi ch will hel p us to eva luate this new servi ce. Your comment

s will hel p us impr ove the servi ce.Thi s survey should onl y take 10 min s of your time

.

BIOHAZARD

SPECIMEN ONLY

OMEGABag 2

OMEGABag 1

f

d

c

a

Saliv

a

jar

e

3

2

1

4

7

6

5

8

How to take a Saliva Sample

Rep

ly P

aid

8000

0TE

ST M

EAt

tn: C

andi

ce F

ulle

rM

elbo

urne

Sex

ual H

ealth

580

Swan

ston

Stre

etC

arlto

n 30

50

No

stam

p re

quire

dIf

post

ed in

Aus

tralia

BIOHAZARD

SPECIMEN ONLY

OMEGABag 2

OMEGA

Bag 1

fd

ca

Saliva jare

321 4

765 8

How to take a saliva sample

Version: 2.2 | 14/02/2017