If 'Yes', please answer the following:
Do you smoke now?Please choose an optionNoYes
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.
MEN: How often do you have EIGHT or more drinks on one occasion?
WOMEN: How often do you have SIX or more drinks on one occasion?
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
How often during the last year have you failed to do what was normally expected of you because of drinking?
In the last year has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down?
If yes, please provide the following information:
Monday to Friday - Alvaston Medical Centre opens at 8am
On the day urgent appointments can be booked by calling 01332 755990 at 8am.
Do you need to See a GP?