5Shot Alcohol Screening Tool 5Shot Your Name * Date of Birth * Your GP/Nurse * Please choose from the listDr CashDr WallsDr BoydDr CalvertDr MacSorleyDr CarswellDr DuffyDr DickieDr MaysonDr DicksonDr WoinANP Claire HillNurse Angela MacArthurNurse Pauline TangNurse Shona SwainNurse Siobhan Badger How often do you have a drink containing alcohol? * (0.0) Never (0.5) Monthly or less (1.0) Two to four times a month (1.5) Two to three times a week (2.0) Four or more times a week How many drinks containing alcohol do you have on a typical day when you are drinking? * (0.0) 1 or 2 (0.5) 3 or 4 (1.0) 5 or 6 (1.5) 7 to 9 (2.0) 10 or more Have people annoyed you by criticising your drinking? * (0.0) No (1.0) Yes Have you ever felt bad or guilty about your drinking? * (0.0) No (1.0) Yes Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hang-over? * (0.0) No (1.0) Yes Scoring Score of 2.5 or greater indicates possible alcohol misuse and the need for further investigation Maximum Score = 7 reCAPTCHA Submit Start Over Δ
