788-792 Whalley New Road, Blackburn, Lancashire, BB1 9BA

Tel: 01254 247 477

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Alcohol Screening Test (FAST)

Please complete all questions below.

Personal Details

Full Name: Date of Birth: Postcode:

Fast Alcohol Screening Test (FAST)

Unit definition: 1 Glass of Wine = 1.5 Units, 1 Bottle = 10 Units, 1 Pint of Beer = 3 Units, 1 Spirit Measure = 1 Unit

Enter the number (0 to 4) that corresponds to your answer in the box.

How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?

0 Never

1 Less than monthly

2 Monthly

3 Weekly

4 Daily or almost daily

How often during the last year have you failed to do what was normally expected from you because of your drinking?

0 Never

1 Less than monthly

2 Monthly

3 Weekly

4 Daily or almost daily

How often during the last year have you been unable to remember what happened the night before because you had been drinking?

0 Never

1 Less than monthly

2 Monthly

3 Weekly

4 Daily or almost daily

Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?

0 No

2 Yes, but not in the last year

4 Yes, during the last year

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I confirm that I am a patient at Brownhill Surgery, Blackburn, Lancashire.

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Alcohol Screening Test (FAST)

Personal Details

Fast Alcohol Screening Test (FAST)

Confirm your Location

Send Your Request

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