Satzuma. Screening Test

Use this form if you are comfortable to share your alcohol issues with us. Alternatively, just use the contact form to send us an email and we will reply to your query as soon as possible.

(Fields with an asterisk () must be filled out).*

Your Name *

Your Email *

Phone number *

Address

Appointments can be made by calling us on 03 6394 3428. Face to face appointments are available Thursdays and Fridays at the rear of Launceston After Hours Medical. Skype appointments are also generally available Thursdays and Fridays, however some other times for Skype may be discussed.

Gender

This is about:
Me
Someone else (Friend or family)

How often do you have a drink containing alcohol?

How many drinks containing alcohol do you have on a typical day when you are drinking?

How often do you have six or more drinks on one occasion?

How often during the last year have you found that you were not able to stop drinking once you had started?

How often during the last year have you failed to do what was normally expected from you because of drinking?

How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?

How often during the last year have you been unable to remember what happened the night before because you had been drinking?

Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?

Screening Test

This Screening Test will help us understand your issues

Use this form if you are comfortable to share your alcohol issues with us. Alternatively, just use the contact form to send us an email and we will reply to your query as soon as possible.

(Fields with an asterisk (*) must be filled out).

(Fields with an asterisk () must be filled out).*