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Score your responses before clicking the "Submit" button (answers will disappear after "Submit" is pressed).
A score of 0-3 for women or 0-4 for men indicates a low risk of health problems related to alcohol use.
A score of 4-12 for women or 5-14 for men indicates "Risky:" an increased risk of health problems related to alcohol use. A brief intervention is indicated.
A score of 13-19 for women or 15-19 for men indicates "Harmful:" an increased risk of health problems related to alcohol use and a possible mild to moderate alcohol use disorder. Intervention or referral to specialized treatment is indicated.
A score of 20+ for women or men indicates "Severe:" an increased risk of health problems related to alcohol use and a possible moderate or severe alcohol use disorder. Referral to specialized treatment is indicated.

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
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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