How often do you drink alcohol?

• Never
• Monthly or less
• 2-4 times per month
• 2-3 times per week
• 4+ times per week

How many drinks do you drink on a typical day when drinking?

• 0-1
• 1-2
• 3-4
• 5-6
• 7+

How often have you had 4 or more drinks if female, or 6 or more if male, on a single occasion in the last year?

• Never
• Less than monthly
• Monthly
• Weekly
• Daily or almost daily

When is the best time to contact you?

• Morning
• Afternoon

Referral Type

• Self-Referral
• Fire
• Police
• Social Prescriber
• Other