Title SelectMrsMsMissMr Name Surname Address Postcode Date of Birth Home Phone Number Work Number Mobile Number Email Address Alcohol 1 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? SelectNeverMonthly or less2-4 times per month2-3 times per week4 or more times per week How many standard drinks containing alcohol do you have on a typical day? Select1 or 23 or 45 or 67 or 89 or more MEN: How often do you have EIGHT or more drinks on one occasion? SelectNeverLess than monthlyMonthlyWeeklyDaily WOMEN: How often do you have SIX or more drinks on one occasion? SelectNeverLess than monthlyMonthlyWeeklyDaily Send
