Alcohol Questionnaire for Adults Your Contact DetailsTitleMrMrsMissMsMxName Forename Surname Date of Birth Day Month Year Mobile NumberHome PhoneEmail Address Address Street Address Address Line 2 City Postcode Alcohol Questions1 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.How often do you have a drink containing alcohol?NeverMonthly or Less2-4 Times a Month2-3 Times a Week4 or more Times a WeekHow many standard drinks containing alcohol do you have on a typical day?1 or 23 or 45 or 67 or 810 or moreMEN: How often do you have EIGHT or more drinks on one occasion? WOMEN: How often do you have SIX or more drinks on one occasion?NeverLess than MonthlyMonthlyWeeklyDaily
