Alcohol Questionnaire

Please answer the questions in the short questionnaire to enable us to assess your alcohol consumption rate and offer advice if necessary.

Alcohol Consumption Questionnaire Form

Alcohol Questionnaire for Adults

Your Contact Details

Name
DD slash MM slash YYYY
Address
Email (Please provide an email address where possible)

Alcohol

1 drink = 1/2 pint of beer or 1 glass of wine or 1 single spirits. 1 unit of alcohol = 10cc of alcohol. So, a small glass (125cc) of 12% wine is 12.5 * 0.12 = 1.5 units.