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Fill out the form below and the results will be emailed to Beth. This information will not be shared with any person or organization. All fields are required and the form will not be sent if any fields are left blank. You will see a message that the form has been sent when the Submit Button is clicked.

Online Alcohol Assessment
How often do you have a drink containing alcohol?
How many drinks do you have per day when you are drinking?
How often do you have four or more drinks on one occasion?
How often in the past year have you found that you were unable to stop drinking once you had started?
How often in the past year have you failed to do what was normally expected of you because of drinking?
How often in the past year have you needed a first drink in the morning to get hourself going after a heavy drinking session?
Click on the icon below to open a printable PDF file of the alcohol assessment
Click on the icon below to download a Word file of the alcohol assessment
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