Teen Drinking Problems

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A red asterisk (*) indicates required questions.


  1. Have you ever been to a party with alcohol?*
    Yes
    No


  1. Have you ever bought alcohol?*
    Yes
    No


  1. Have you ever passed out from drinking?*
    Yes
    No


  1. how much can you drink before passing out?  *


  1. Do you like to Drink*
    Yes
    No


  1. Have you ever lost a friend to alcohol *
    Yes
    No
    I dont have Friends


  1. How often do you drink.*
    Once month
    Every day
    Weekends only
    I dont drink


  1. Who do you drink with ?*
    Parents
    Friends
    Teachers
    Alone cause i have no friends
    I dont drink


  1. Have you ever drank and drove *
    Yes
    NO


  1. What is your favorite thing to drink?*
    Mixed Drinks
    Miller Light
    Coors Light
    Bud Light
    dont drink





Teacher
Glidden-Ralston
Glidden, IA