Audit C Questionnaire
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
1. How often did you have a drink containing alcohol in the past year?
*
Never
Monthly or less
2-4 times a month
2-3 times a week
4 or more times a week
2. How many drinks did you have on a typical day when you were drinking in the past year?
*
None, I do not drink
1-2
3-4
5-6
7-9
10 or more
3. How often did you have six or more drinks on one occasion in the past year?
*
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
Total
Submit
Should be Empty: