Old Mill Surgery

02476 382554

Alcohol questionnaire

Please complete the form as fully as possible to enable us to process the information efficiently.

  • Date Format: DD slash MM slash YYYY
  • Alcohol

    1 drink = 1/2 pint of beer or 1 glass of wine or 1 single spirits. 1 unit of alcohol = 10cc of alcohol. So, a small glass (125cc) of 12% wine is 12.5 * 0.12 = 1.5 units.