Have you ever tried to stop using drugs but couldn’t ? Yes No Do you ever feel ashamed or guilty after using drugs or alcohol? Yes No Has a friend or relative ever expressed concern about your drug or alcohol use ? Yes No While under the influence of alcohol or drugs, have you gotten into fights with other people? Yes No Have your ever lost a job or realised your work quality has suffered due to drug or alcohol use? Yes No Have you been arrested for offending while under the influence of alcohol or drugs? Yes No Have you ever participated in illegal activities in order to get your drugs? Yes No When you stop taking your drug, do you experience any withdrawal symptoms or cravings? Yes No Have you ever had medical problems such as memory loss, hepatitis, convulsions, bleeding, etc. as a result of your alcohol or drug use? Yes No CommentsThis field is for validation purposes and should be left unchanged. If you have answered YES to any of these questions, please make an appointment to speak to one of our Medical Practitioners to discuss your concerns.
