3200 N. Hayden Rd, Suite 105, Scottsdale, AZ 85251
+1.480.809.6230

questionnaire

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In the past 12 months, have you or a loved one awakened the morning after some drinking the night before and found that you/they could not remember a part of the evening?

YesNo

Does any near relative or close friend ever worry or complain about your drinking or theirs?

YesNo

Can you or a loved one stop drinking without difficulty after one or two drinks?

YesNo

Has drinking ever created problems between you and a near relative or close friend?

YesNo

Do you or a loved one drink before noon fairly often?

YesNo

Have you or a loved one ever gotten into trouble at work because of drinking?

YesNo

Have you or a loved one ever been told you have liver trouble such as cirrhosis or any other health issues related to your drinking?

YesNo

Have you or a loved one ever been arrested for driving under the influence of alcohol?

YesNo

Have you or a loved one ever been arrested, even for a few hours because of other behavior while drinking?

YesNo




Do you or a loved one drink to relieve tension or stress?

YesNo

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