PLEASE READ:This survey is provided by SlickRock Marketing and Design as an educational tool and an example of the services we can provide for the health care industry. We make no claims as to the validity of the results, nor should this be a substitute for professional medical advice. This is a published survey that we have converted into digital form and is self-scoring.

Fill out this survey and it will help you evaluate your drinking patterns. As soon as you finish answering these 9 questions hit the "score survey" button and this survey will assess whether you may have a problem with alcohol based on your answers to the questions below. The self-assessment scoring is done by javascript and thus your answers are stored and scored only within your own computer's memory. No records of individual responses are seen by our servers, and there will be no attempt to identify any visitor to this page.

1. Do you feel that you are a normal drinker (no more than average)?
   Yes
   No 
   

   
   

2. Do close relatives ever worry or complain about your drinking?
   Yes
   No 
   

   
   

3. Are you always able to stop drinking when you want to?
   Yes
   No 
   

   
   

4. Has your drinking ever created problems between you and your spouse, parent or other near relative?
   Yes
   No 
   

   
   

5. Do you ever drink in the morning?
   Yes
   No 
   

   
   

6. Have you ever felt the need to cut down on your drinking?
   Yes
   No 
   

   
   

7. Have you ever been told by a doctor to stop drinking?
   Yes
   No 
   

   
   

8. Have you ever been a patient in a psychiatric hospital or on a psychiatric ward because of problems related to drinking?
   Yes
   No 
   

   
   

9. Have you ever been arrested, even for a few hours, because of driving while intoxicated?
   Yes
   No