Alcohol Questionnaire

It is well known that alcohol should be consumed in moderation.  If you feel concerned about your alcohol consumption, please feel free to make an appointment with Ceinwen (Assistant Practitioner) to discuss your concerns.  Please download the questionnaire below, answer the questions which will enable us to assess your alcohol consumption rate, and give it to the doctor or nurse at your appointment, who will be able to offer advice and support if necessary.

Please either submit the form on-line, or print it and send/hand it to us; as with all patient information, your form is treated in the strictest confidence.

Alcohol Consumption Questionnaire

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