2/22/2019 Alcohol Consumption

Alcohol Consumption
Hi !
The purpose of this questionnaire is to find out the alcohol consumption details of an individual.
The survey is anonymous, so please answer as truthfully and accurately as possible.

Note:Take this survey if you are 18 years or above

Thank you!

* Required

1. 1. What is your age? *

2. 2. What is your gender? *

Mark only one oval.

Male
Female

3. 3. At what age did you start consuming

alcohol? *

4. 4. Why did you start consuming alcohol? Pick one *

Mark only one oval.

Influence of an adult
Peer pressure
Curiosity
Because you 'felt like it' (Bored)

5. 5. How often do you drink? *

Mark only one oval.

Every day
3-5 times a week
Once a week
Only on weekends
On special occasions

6. 6. Do you engage in binge drinking? (5 or more drinks in a sitting) *

Mark only one oval.

Yes
No

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2/22/2019 Alcohol Consumption

7. 7. Estimate the number of hours you drank the last time you socialized *
Mark only one oval.

None
One hour
2-3 hours
4-5 hours
More than five hours

8. 8.Do you ever drink to get drunk? *

Mark only one oval.

Yes
No

9. 9. Has your drinking ever caused problems at home? *

Mark only one oval.

Yes
No

10. 10.Do you ever feel guilty about your drinking? *

Mark only one oval.

Yes
No

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