Alcohol Consumption ReviewAlcohol Consumption Review Full Name:*Date of Birth:*Please use date format DD/MM/YYYYONE UNIT OF ALCOHOL IS EQUIVALENT TO: 1/2 pint or regular beer or cider or 1 small glass of wine or 1 single emasure of spirits or 1 small glass of sherry or 1 single measure of aperitifs.How often do you have a drink containing alcohol?* Never Monthly or less 2-4 times per month 2-3 times per week 4+ times per weekHow 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 have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?* Never Less than monthly Monthly Weekly Daily or almost dailyPlease select your current smoking status from the drop down list*Never smoked tobaccoEx SmokerCurrent SmokerReady/Thinking about stopping smokingWould rather not give smoking statusIf you are ready or thinking about stopping smoking for further information and support please visit our NHS Smokefree Support Service page which can be found under the Services heading on our main menu.
