Summervale Surgery

Summervale Surgery

Canal Way, Ilminster, Somerset, TA19 9FE

Sorry, we're currently closed. Please call NHS 111

NHS

Telephone: 01460 52354

Out of Hours: 111

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Please note we are closed for training on the first Wednesday afternoon of each month from 1pm until 4pm.

 

Alcohol Questionnaire

Know your units: Pint of Regular beer/lager/cider = 2 units Alcopop or can of lager = 1.5 units Glass of wine (175ml) = 2 units Single measure of spirits = 1 unit Bottle of wine = 9 units
Name
DD slash MM slash YYYY
Q1. How often do you have a drink that contains alcohol?
Q2. How many standard alcoholic do you have on a typical day when you are drinking?
Q3. How often do you have 6 or more standard drinks in one occasion?
Now add up your scores from Q1-Q3. If you have scored 5 or more, please complete the rest of the questionnaire. If you scored less than 5 points, you may skip questions Q4-Q10 and simply press the submit button at the end.
Q4. During the past year, how often have you found that you were not able to stop drinking once started?
Q5. During the past year, how often have you failed to do what was normally expected of you because of drinking?
Q6. During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session?
Q7. During the past year, how often have you had a feeling of guilt or remorse after drinking?
Q8. During the past year, have you been unable to remember what happened the night before because you had been drinking??
Q9. Have you or someone else been injured because of your drinking?
Q10. Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down?
This field is for validation purposes and should be left unchanged.