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 Questionnaire for Adults

Your Contact Details

Name
DD dash MM dash YYYY
Address

Alcohol

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