Drinking Habits Survey
  • Name
  • Date of birth
  • Gender
  • Occupation
  • What sort of drinker are you?
  • What do you drink, typically?
  • What are your favorite alcoholic beverages? Please list them below.
  • How often do you drink?
  • Where do you usually drink?

  • How much do you spend a month on drinking?
  • Is there family history of alcoholism?
  • please specify
  • Does anyone close to you drink heavily?
  • please specify:

That's all, folks!