Alcohol Consumption Review

If you have been invited to submit an alcohol consumption review, please complete this form.

Sandy Holder,Alcohol Liaison Nurse works at the practice for at least one session each week. If you are concerned about your drinking, please contact her via reception and she will contact you.

Alternatively, please fill out the form below. The Practice will arrange any necessary appointments based on the information that you provide.

Alcohol Consumption Review

About You

Please use this date format: DD/MM/YYYY.
Responses we send will go to this email address

Alcohol Consumption

This is one unit of alcohol:

And each one of these, is more than one unit:

This is your total score from the first part of the Alcohol Consumption form.

Alcohol Consumption - Part 2

A total of 5+ indicated increasing or higher risk of drinking. As you have scored 5 or more, please now fill in the questions below.
This is your total score the Alcohol Consumption form.

Please note that the details you give will be used to update your medical records.