GASP UK is the LGBT alcohol support and domestic abuse network

Questionaire

GASP (UK) is an LGBT Alcohol Support & Domestic Abuse Service established to provide the LGBT community with a link to alcohol support including long term recovery/aftercare and supporting victims of domestic abuse, be it Physical, Mental, Financial OR Sexual Abuse.

CONFIDENTIAL QUESTIONNAIRE Scroll down using bar on right.

Gender

Male Female
Is your gender the same as at birth?

Yes No
Are you

Gay Lesbian Bi Sexual Heterosexual Other
If answered other please state
Age Group

U18 18-20 21-25 26-30 31-40 41-54 55+
Religious Faith
Ethnicity
First part of Postcode( Eg FY1)
Are you registered Disabled
Welcome to the CAGE Questionnaire. A screening test for Alcohol dependence.
1. Have you ever felt you could cut down on your drinking?
2. Have people annoyed you by criticising your drinking?
3. Have you ever felt bad or guilty about your drinking?
4. Have you ever had a drink in the morning to steady your nerves or get rid of a hangover (Eyeopener)?
How often do you have an alcoholic drink?

Daily 2/3 times weekly 2/3 times monthly Monthly or less
If you were dependent on alcohol or had any problems which of the following services would you prefer to help you?

LGBT Specific service LGBT friendly Any
If you were dependent on alcohol or had any problems which people would you prefer to help you?

Someone who has been dependent themselves and now in recovery/alcohol free Someone else
Should be Empty:

Welcome to the CAGE Questionnaire. A screening test for Alcohol dependence.