Millbrook Surgery

01963 350210
Prescriptions: (11am to 4pm only)
01963 359354

Alcohol Questionnaire

Please answer the questions in the short questionnaire to enable us to assess your alcohol consumption rate and offer advice if necessary.

  • Date Format: DD slash MM slash YYYY
  • Alcohol

    1 drink = 1/2 pint of beer or 1 glass of wine or 1 single spirits. 1 unit of alcohol = 10cc of alcohol. So, a small glass (125cc) of 12% wine is 12.5 * 0.12 = 1.5 units.
  • This field is for validation purposes and should be left unchanged.