Alcohol self-assessment form First name Last name Email Confirm email Phone number How often do you have a drink containing alcohol? Never Monthly or less 2-4 times a month 2-3 times a week 4 or more 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 do you have 8 or more units on one occasion? Never Less than monthly Monthly Weekly Daily or almost Privacy Consent This form collects personal and medical informanot tion about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data. Privacy Consent