Alcohol Consumption Review

If you have been invited to submit an alcohol consumption review, please submit this form.

Full Name

Phone Number

Email Address

How often do you have a drink containing alcohol?

Never

Monthly or less

2-4 times per month

2-3 times per week

4+ times per week

How many units of alcohol do you drink on a typical day when you are drinking?

1-2

3-4

5-6

7-9

10+

How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?

Please note that the details you give will be used to update your medical records.

Never

Less than monthly

Monthly

Weekly

Daily or almost daily

Important: