Questionnaire Please answer the following questions, you will then be given feedback on the best way we can help. Name * First Name Last Name Email * Contact Number * 1. Do you ever use alcohol or drugs to relax, to feel better about yourself, or to fit in? * Yes No 2. Do you ever use alcohol or drugs while you are alone? * Yes No 3. Do you ever forget things you did while using alcohol or drugs? * Yes No 4. Do your family or friends ever tell you that you should cut down on your drinking or drug use? * Yes No 5. Have you ever been trouble while you were using alcohol or drugs? (this could include at school, home or with the Police) * Yes No From your answers we think it would be good for you to have a chat with us. Please contact us here
