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Alcoholism Testing Form

An alcoholism testing form is a questionnaire administered by doctors to patients who are suspected of drinking alcohol excessively.

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Please answer the following questions truthfully.

Email*

What is your full name?*

What is your date of birth?*

Select date

What is your current occupation?*

How often do you drink alcohol?*

How much alcohol do you consume on a typical day?*

Less than 1 drink

1-2 drinks

3-4 drinks

5 or more drinks

Have you ever tried to quit drinking alcohol?*

Yes

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Description:Assess Alcoholism with an Alcoholism Testing Form

An alcoholism testing form is a questionnaire administered by doctors to patients who are suspected of drinking alcohol excessively. This form helps doctors to assess the severity of alcoholism and determine the appropriate treatment plan. The form includes questions about the patient's drinking habits, family history, and any symptoms they may be experiencing. By using this form, doctors can accurately diagnose alcoholism and provide patients with the necessary support and resources to overcome their addiction. Take the first step towards recovery by filling out an alcoholism testing form today.

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Last Name*

Date of Birth*

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Full Name*

Age*

Gender*

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What is your gender?*

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Phone Number*

Address*

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Date of Birth*

Address*

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