About My Drinking Screening Tool

The 18 question screening tool is anonymous and has been designed to help you, your loved ones or your health care professional answer some questions about drinking. When you have finished the test you can print or email your Final Report directly to yourself or your health care professional.

Please begin the survey by filling in the following anonymous information. Assuring security and confidentiality are hallmarks of Hazelden. Hazelden does not provide or release names or email addresses to any third party. Please see the Privacy Policy in the site footer for details.

Your user name:  (to protect your privacy please use a nickname)  

You are:

Your date of birth: 

Your email address is:       
After you sign up we’ll send you your registration information.

The password you would like to use is:     
Password note: To protect your privacy, please choose a secure password that contains at least 8 characters of both letters and numbers.

How much do you weigh?

You are taking this test:

How much would you say that each drink costs you?  $  (example: 3.75)

Please Note: By clicking "Start the Screening" you acknowledge that this screening is for educational puposes only and is not to be used as a substitute for a consultation or visit with your family physician or other healthcare provider.

Statistical data collected throughout the site is used for research purposes only. Individual statistics are not collected or distributed and we do not collect or distribute email addresses or any other personal information. Please read this important legal information.