• Daily Life Experiences

  • This questionnaire consists of twenty-eight questions about experiences that you may have in your daily life. We are interested in how often you have these experiences.

    It is important, however, that your answers show how often these experiences happen to you when you are not under the influence of alcohol or other drugs.

    To answer the questions, please determine to what degree the experience described in the question applies to you, and drag the slider to show approximately what percentage of the time you have the experience.


    0% is never and 100% is always

  • Thank you for taking time to complete this questionnaire.

    Please Review your answers, if neccessary, and then just hit the Submit button below and the responses will be sent to me. You can also Print the form for your own records. The Reset button will clear all the answers.

    We will review and discuss the results when we next meet.

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